Detecting Pregnancy

Detecting whether you are pregnant or not can sometimes be confusing, especially if it’s your first pregnancy. In most cases, it will have to take a visit to the hospital for your doctor to confirm if you are pregnant. The doctor needs to rule out other possible conditions that can present with similar clinical features like pregnancy. These can include uterine fibroids, ovarian cysts, distended bladder and pseudocyesis (or false pregnancy, where the woman only believes she is pregnant).

A number of symptoms and signs are detectable by both you and your doctor when pregnancy occurs. The signs and symptoms persevere through out pregnancy and are very important markers for the continuous diagnosis of a viable pregnancy until you put to birth.

Detectible Symptoms 

It will not be possible to make a certain diagnosis of pregnancy from just one sign or symptom. You need a combination of these signs and symptoms to detect pregnancy especially in the first trimester. The use of pregnancy test and imaging studies are the absolute confirmatory diagnostic technique for detecting pregnancy in a woman.

Here are some detectible symptoms which you may observe that suggests you have a viable pregnancy :

  • Amenorrhea : Amenorrhea or absent menstruation is the earliest symptom of pregnancy. If a healthy woman whose menstrual periods were previously regular, suddenly has a cessation of menstruation, the presumption must always  be that she is pregnant unless some other cause of Amenorrhea can be found.
  • Breast symptoms : In the early weeks of pregnancy, some tenderness and fullness of the breast may be noticed. Your breasts increase in size due to the proliferation of the glands and ducts of the breast under the influence of estrogen and progesterone.
  • Urinating Frequently : During the first 12 weeks, when the uterus is still down at the pelvis, you will often experience some frequency of urination. This is because the enlarging uterus presses on your bladder lightly, particularly when you are standing during the day time.
  • Abdominal enlargement : Many women notice some abdominal fullness in early pregnancy at a time when the uterus is not much enlarged. Later on, the uterine enlargement becomes evident and sometimes it becomes the first thing that brings the woman to the hospital especially in cases where the menstrual periods were previously irregular.  A woman’s abdomen may swell because of other reasons like fat or ovarian cyst and not pregnancy.
  • Fetal movements : A primigravida (woman pregnant for the first time) usually feel her baby kicking for the first time called quickening between 16th to 20th week of pregnancy. However a woman who has delivered before May recognise the movements 2 or 3 weeks earlier. This symptom is very subjective and as such, is not of much value in the diagnosis of pregnancy.

Detectible Clinical Signs

Pregnancy is more accurately determined by a doctor in the clinic. Here are some of the signs that he will observe to confirm your pregnancy and the well-being of your unborn child in the womb :

  • Enlargement of the body of the uterus  : A slight enlargement of the body of the uterus is the earliest alteration from pregnancy which can be detected clinically. Although it is difficult to be certain of this if you have had a previous pregnancy. Your doctor will try to feel the level of your uterus with his hand over your belly. The level is supposed to continually be increasing from your lower abdomen to just below your sternum as the pregnancy progresses.
  • Softening of the uterus and cervix  : Your uterus and cervix softens duering pregnancy due to increased vascularity.  The blue colouration of the cervix soon follows the softening of the uterus and are usually complete by the 16th week.  When these signs are markedly noticed, they are a reliable sign of pregnancy.
  • Painless contractions  : When your doctor properly examines you, these contractions can be felt even when the uterus is still in the pelvis. As the uterus rises up into the abdomen, the contractions are more easily felt and are reliable evidence that the enlargement is in fact a pregnant uterus.
  • Fetal heart sounds : On auscultation of the abdomen with a sonicaid, your doctor can hear the fetal heart sounds after the 12th week of your pregnancy. The fetal heart rate varies between 120 – 160 beats per minute which is roughly double of your pulse rate.
  • Palpation of fetal parts : Palpation of fetal parts is usually possible from the 24th week onward. At a later stage in your pregnancy, the definite recognition of the head, back and limbs of the fetus confirm pregnancy without any doubt.
  • Funic souffle : The funic souffle is a soft blowing murmur that can be heard at the same time  with the fetal heart sounds. It is occasionally heard by the doctor if the sonicaid happens to be placed directly over the umbilical cord.

Pregnancy Test and Imaging

These are the most definite ways to detect early pregnancy. A pregnancy test depends on the detection of large quantities of the human chorionic gonadotropin (hCG) which is produced due to pregnancy. hCG is a glycoprotrein that is found in maternal circulation after fertilisation and it is excreted in maternal urine after implantation. This is the basis for doing pregnancy test on the urine and blood. Usually, pregnancy test on the blood can pick up hCG levels as early as 2 weeks after conception, whiles in urine, hCG can be noticed after 2 – 4 weeks.

With a real time ultrasound scan, the gestational sac can often be seen as early as 5 weeks from the first day of your last menstrual period. A week later, echoes from the embryo within the sac can be obtained and cardiac pulsation of the fetus may be recognised,  particularly if a transvaginal transducer is used.

Reference

  • G. Chamberlain: Obstetrics by Ten Teachers, “Normal Pregnancy” (16th edition).

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