The first signs of pregnancy, reliable signs. Diagnosis of pregnancy. Determining the duration of pregnancy

25.05.2019

In modern conditions, the determination of the characteristic clinical signs of pregnancy is of an auxiliary nature and is the basis for the appointment of the "gold standard" for the diagnosis of pregnancy. According to the diagnostic value, the characteristic signs of pregnancy can be divided into three groups:

Dubious (presumptive) signs of pregnancy - associated with the subjective feelings of the pregnant woman and somatic changes in her body;
· Probable signs of pregnancy - signs determined by an objective examination of the organs of the reproductive system, and positive immunological tests for pregnancy;
· Reliable (undoubted) signs of pregnancy - objective signs associated with the presence of the fetus itself (determined in the second half of pregnancy).

Doubtful signs of pregnancy:

· Changes in appetite (aversion to meat, fish, etc.), whims (attraction to spicy dishes, to unusual substances - chalk, clay, etc.), nausea, vomiting in the morning;
· Changes in olfactory sensations (aversion to perfume, tobacco smoke, etc.);
· Changes in the nervous system: irritability, drowsiness, instability of mood, etc.;
· Pigmentation of the skin on the face, along the white line of the abdomen, nipples and areola;
· A feeling of engorgement of the mammary glands;
· Increased frequency of urination;
· An increase in the volume of the abdomen.

Likely signs of pregnancy:

Cessation of menstruation;
· The appearance of colostrum from the milk ducts opening on the nipple when pressing on the mammary glands;
• cyanosis (cyanosis) of the vaginal mucosa and cervix;
· Change in the size, shape and consistency of the uterus;
· Laboratory tests (determination of chorionic hormone in urine and blood).

Identification of probable signs of pregnancy is carried out by: interviewing; examination and palpation of the mammary glands; examination of the external genital organs and the entrance to the vagina; research using mirrors; vaginal and two-handed vaginal-abdominal examination of a woman.

A delay in menstruation is an important symptom, especially in women with a regular cycle. The significance of this symptom increases if it is combined with engorgement of the mammary glands and the appearance of colostrum in them, with the onset of cyanosis of the vagina and especially the vaginal part of the cervix, with a change in the size and consistency of the uterus.

With the onset of pregnancy, as pregnancy progresses, the size of the uterus changes. The change in the shape of the uterus is determined with a two-handed (bimanual) examination. The uterus in non-pregnant women is pear-shaped, somewhat compacted in the anteroposterior size. With the onset of pregnancy, the shape of the uterus changes. From 5-6 weeks, the uterus acquires a spherical shape. Starting from 7-8 weeks, the uterus becomes asymmetrical, one of its corners can protrude. By about 10 weeks, the uterus becomes spherical again, and by the third trimester of pregnancy it acquires an ovoid shape. Conventionally, you can use the following rule: at 8 weeks, the body of the uterus increases 2 times compared to its original size, at 10 weeks - 3 times, at 12 weeks - 4 times.

The following signs indicate pregnancy.

Enlargement of the uterus. It is noticeable at 5-6 weeks of pregnancy; The uterus first increases in the anteroposterior direction (becomes spherical), later its transverse size also increases. The longer the gestation period, the clearer the increase in the volume of the uterus. By the end of the second month of pregnancy, the uterus increases to the size of a goose egg, at the end of the third month of pregnancy, the bottom of the uterus is at the level of the symphysis or slightly above it.

Horwitz – Gegar sign. The consistency of the pregnant uterus is soft, and the softening is especially pronounced in the isthmus. In a two-handed study, the fingers of both hands meet in the isthmus region with almost no resistance.

Snegirev's sign. Pregnancy is characterized by slight variability of the consistency of the uterus. The softened pregnant uterus, during a two-handed examination, becomes denser and shrinks under the influence of mechanical irritation. After the termination of irritation, the uterus regains a soft consistency.

Piskacek sign. In the early stages of pregnancy, there is often an asymmetry of the uterus, depending on the dome-shaped protrusion of the right or left corner of it from 7-8 weeks. The protrusion corresponds to the site of implantation of the ovum. As the ovum grows, the protrusion gradually disappears (by 10 weeks).

Gubarev and Gaus drew attention to the slight mobility of the cervix in the early stages of pregnancy. Easy displacement of the cervix is associated with significant softening of the isthmus.

Genter's sign. In the early stages of pregnancy, there is an increased bend of the uterus anteriorly, resulting from a strong softening of the isthmus, as well as a ridge-like thickening (protrusion) on the anterior surface of the uterus along the midline. This thickening is not always determined.

Credible signs of pregnancy:

· Determination (palpation) of parts of the fetus. In the second half of pregnancy, palpation of the abdomen reveals the head, back and small parts (limbs) of the fetus;
• clearly audible fetal heart sounds. With simple auscultation (with an obstetric stethoscope), fetal heartbeats can be heard after 18–20 weeks;
· Fetal movements felt by the doctor when examining a pregnant woman.

The diagnosis of pregnancy is accurate even when there is only one reliable symptom.

In the early stages, pregnancy can go completely unnoticed and be a surprise for a woman. But there are times when a woman almost from the first day of conception has nausea and vomiting. More often, such extremes do not happen, and the first signs of pregnancy are present, but they are not so noticeable.

Types of pregnancy signs

Some women immediately, instinctively, even without pronounced signs, realize that they are pregnant. For others, this is not given and pregnancy for them is a surprise, sometimes belated, since in some cases women have a slight menstrual bleeding, which they mistake for menstruation.

And yet there are both subjective and objective ... Obstetricians-gynecologists divide all signs of pregnancy into dubious (mostly different sensations of a woman), probable (this is something that can be seen or felt) and reliable (confirming pregnancy or clearly indicating its presence). Already in the early stages of pregnancy, all three of these types of signs can be detected.

Doubtful (subjective) signs of pregnancy

Doubtful signs can be very different. Most often, in the first weeks of pregnancy, a woman simply feels that something is wrong with her. These signs are therefore called dubious, because in some cases they are either not caught, or the woman (especially if she really wants a child) simply thinks that she has such signs. Doubtful signs of pregnancy include:

Sometimes, already from the first weeks of pregnancy, signs of toxicosis begin - nausea, vomiting, salivation. These signs can be easy or hard. This condition lasts for the first twelve to fourteen weeks, and then, when the placenta begins to function, it passes.

Probable (objective) signs of pregnancy

Probable signs of pregnancy are objective changes in the genitals and mammary glands of a pregnant woman. Probable signs are signs that always accompany pregnancy, but they can also occur with some gynecological diseases, including changes in hormonal levels. Likely signs of pregnancy include:

Reliable (confirming) signs of pregnancy

Credible signs of pregnancy confirm pregnancy. In the early stages, these are signs that can be seen on ultrasound examination (ultrasound). After about three weeks, a fertilized egg can be seen in the uterine cavity, having penetrated into the wall of the uterus, and after seven weeks the fetal heartbeat is already determined.

Reliable signs of pregnancy laboratory tests also apply. This is the determination in the blood of a pregnant woman of the concentration of hCG (a quantitative indicator that grows up to the tenth week of pregnancy) and trophoblastic gamma globulin (it appears in the blood only during pregnancy).

History and modern technologies

The diagnosis of pregnancy has worried people for a long time. To find out if a woman was pregnant in ancient Egypt, she was given a drink made from a special herb (bududu-ka) and the milk of a woman who gave birth to a boy. If this drink caused vomiting, then the woman is pregnant, otherwise there was no pregnancy. To determine pregnancy, the ancient Jews forced a woman to walk on soft grass: if there was a deep trace, then pregnancy existed.

The midwives of ancient Greece already possessed considerable knowledge. So, to determine pregnancy, they were based on a number of objective signs: absence of menstruation, lack of appetite, salivation, nausea, the appearance of yellow spots on the face. At the same time, they also resorted to such ridiculous means: they rubbed a red stone in front of the woman's eyes, and if dust got into her eyes, the woman was considered pregnant, otherwise the pregnancy was denied. Even Hippocrates (460-377 BC) had many false and mistaken ideas about pregnancy. In particular, he believed that pregnancy could be recognized by the eyes, but at the same time, he considered the cessation of menstruation to be one of the first signs of pregnancy.

Soranus of Ephesus(1st century AD) established the following signs of pregnancy: periods are delayed, the mammary glands swell, and the vessels of the skin of the mammary glands become convoluted, acquire a bluish tint and swell; there is an urge to vomit; dark circles appear under the eyes, and sometimes yellow spots on the face; over time, the abdomen increases and the pregnant woman begins to feel the movements of the fetus.

The diagnosis of pregnancy has been gradually improved in accordance with the development of human society. Today, the diagnosis of pregnancy is made on the basis of a survey, an objective examination of a woman and laboratory research methods.

The signs of pregnancy, according to their diagnostic value, are divided into presumptive and probable, which appear relatively early, and reliable, usually found from the second half of pregnancy. It is therefore quite understandable that it is impossible to use reliable signs for the early diagnosis of pregnancy.

Among the presumptive (doubtful) signs that appear early, although not with every pregnancy, but still have some diagnostic value, are the following.

Dyspeptic disorders, a feeling of heaviness in the epigastric region, salivation, nausea, morning vomiting on an empty stomach, changes in appetite or aversion to certain types of food (usually meat), the emergence of a special addiction to spicy and especially sour foods, constipation, desire to eat inedible substances - lime, chalk, clay, etc.
Functional disorders of the nervous system and psyche: slight irritability, exacerbation of smell and hearing, tearfulness, withdrawal.
Changes in metabolism: deposition of subcutaneous fat, especially on the abdomen, pigmentation of the nipples and areola, the white line, and sometimes the face.
The appearance of stripes (scars) of pregnancy.
All these signs are often found in pregnant women, but are not necessarily associated with pregnancy, and therefore are called hypothetical.

The following are likely signs.
Cessation of menstruation in a healthy, sexually active woman of childbearing age.
Congestion is a bluish color of the mucous membrane of the entrance to the vagina, its walls and the vaginal part of the cervix. An increase in the size of the uterus in accordance with the period of delay in menstruation, a change in its usual shape and consistency.
Engorgement of the mammary glands and the appearance of colostrum in them.
All these signs in most cases really characterize pregnancy, but sometimes they can be the result of other reasons. For example, a delay in menstruation can be of a psychogenic nature; the cause of the enlargement of the uterus is a growing tumor. Therefore, the listed signs of pregnancy are valuable not individually, but in aggregate.

Reliable (undoubted) signs include the following.
Determination of parts of the fetus when feeling the uterus; the easiest way to determine is the round, dense part - the head, as well as the small parts - the arms and legs.
Stirring of the fetus, determined by the examiner's hand.
Listening to the fetal heartbeat with a stethoscope or with a heart rate monitor.
These signs 100% certify pregnancy, but they are late, since they can be noted only from the end of the 4th or beginning of the 5th month of pregnancy.

One of the important points in the diagnosis of pregnancy is a vaginal examination and palpation of the uterus, so this should be discussed in more detail. The size of a normal non-pregnant uterus along the longitudinal axis is approximately 7-9 cm (in non-pregnant women, somewhat less, in those who have given birth, somewhat more). With the onset of pregnancy and in the process of its development, the size of the uterus increases. Until the end of the third month of pregnancy, the uterus is still in the pelvic cavity and can only be felt during vaginal examination. Only after this period, no longer fitting in the small pelvis, the uterus leaves it and can be felt from the side of the abdominal wall, and subsequently leads to a noticeable increase in the abdomen.

A normal non-pregnant uterus is usually pear-shaped, somewhat flattened anteroposteriorly. With the onset of pregnancy, in the process of its further development, the shape of the uterus changes. At first, it takes a spherical shape, then somewhat asymmetric, then again spherical and by the end of pregnancy it is ovoid. Acquisition of a spherical shape by the uterus, along with other signs, is very characteristic of pregnancy. The spherical shape of the uterus can be noted as early as 5-6 weeks of pregnancy, and this shape can persist up to about 9-10 weeks. Starting from 7-8 weeks of pregnancy, the uterus becomes asymmetric, namely: one of its corners protrudes somewhat, as if bulging in comparison with the opposite side. The appearance of asymmetry is due to the fact that the implantation of a fertilized egg in the uterine cavity usually occurs near the mouth of the tube through which the egg was transported. This feature of the shape of the uterus during the indicated period of pregnancy was first noted by Piscacek and proposed by him as a diagnostic feature. In the future, with the development of pregnancy, the asymmetry of the body of the uterus disappears, and then the Piskachek symptom will no longer be determined.

The consistency changes with the onset of pregnancy: it becomes much softer. Softening of the uterus occurs due to an increase in the size and number of muscle fibers due to the enrichment of the organ with blood, stagnation. Particular softening is noted in the isthmus of the uterus.

Sometimes the softening is so pronounced that when examined, the body of the uterus appears to be separated from the cervix. The second feature of the pregnant uterus is the inconstancy of its consistency. When examining a pregnant uterus, at first, its softish consistency is noted, and in the process of research, the uterus becomes denser. Such a change in the uterus at the time of examination is a particularly characteristic sign for pregnancy.

It is not always possible to diagnose a very early pregnancy with an internal obstetric examination, since the main signs of pregnancy obtained in this case can be detected no earlier than 5-6 weeks of pregnancy. Before this period, pregnancy does not yet lead to tangible changes in the uterus. Even with a longer period, sometimes complete confidence in the accuracy of the data obtained is not created. Meanwhile, it is often required to establish the presence of pregnancy before 5 weeks, for example, for the production of a mini-abortion.

The imperfection of the palpation method for early diagnosis of pregnancy has long directed the idea of finding other methods based on identifying those changes in a woman's body that occur with the onset of pregnancy.

The study of biochemical changes occurring in the body of a pregnant woman made it possible to propose various reactions with the help of which they tried to diagnose pregnancy. The evolution of these methods was quite long and continues to this day. At the same time, the methods were improved in parallel with the development of science and the emergence of new knowledge, and particular successes are associated with the development of biochemistry and immunology. All methods are based on the detection in the blood or urine of a woman of the pregnancy hormone - chorionic gonadotropin. This substance is found in a woman's blood by modern techniques within a week after conception.

The most widespread is the rapid diagnosis of pregnancy using test systems., which are based on the principle of chromatography. The sensitivity of the test is sufficient for almost 100% accurate diagnosis of pregnancy on the 1st day of the delay in the expected menstruation, and often it is possible and 3-5 days earlier than the delay. With the help of such a test, in many cases, an ectopic pregnancy is also detected, however, it is impossible to distinguish it from a uterine pregnancy on the basis of this test alone. Now on sale there are various diagnostic tests that allow you to independently identify the presence of pregnancy at home. Most often, such a test is a test strip immersed in urine for 1-2 minutes. The presence of pregnancy is judged by the number of colored stripes.

The diagnosis of pregnancy is undoubted if, during the examination, parts of the fetus, heartbeat and movement of the fetus are determined, and during ultrasound examination - the ovum. These reliable signs of pregnancy do not appear at the beginning of it, but at a later date (V-VI month). In the early stages, the diagnosis of pregnancy is established on the basis of hypothetical and probable signs.

Suspected (doubtful) signs of pregnancy

Presumptive signs include manifestations of general changes associated with pregnancy:

changes in appetite (aversion to meat, fish, etc.), whims (attraction to spicy dishes, to unusual substances - chalk, clay, etc.), nausea, vomiting in the morning;

changes in olfactory sensations (aversion to perfume, tobacco smoke, etc.);

changes in the nervous system: irritability, drowsiness, mood instability, etc.;

pigmentation of the skin on the face, along the white line of the abdomen, nipples and areola.

Likely signs of pregnancy

This group of signs includes changes in menstrual function and changes in the genitals:

cessation of menstruation;

the appearance of colostrum from the milk ducts opening on the nipple when pressing on the mammary glands;

cyanosis (cyanosis) of the vaginal mucosa and cervix;

change in the size, shape and consistency of the uterus;

laboratory tests (determination of chorionic hormone in urine and blood).

Credible signs

Determination of fetal parts by palpation of a woman's abdomen (Leopold's techniques).

Determination of fetal movements during palpation: the sensation of fetal movement on palpation or ultrasound.

Listening to fetal heart sounds. The diagnosis of pregnancy is confirmed by listening to fetal heart sounds, the frequency of which is 120/140 per minute. Heartbeats can be determined from 5-7 weeks using instrumental research methods: ECG, phonocardiography, cardiotocography, ultrasound, and from 17-19 weeks - auscultation.

The identification of probable signs of pregnancy is done by:

palpation of the mammary glands and squeezing out colostrum;

examination of the external genital organs and the entrance to the vagina;

research using mirrors;

vaginal and two-handed vaginal-abdominal examination of a woman.

With the onset of pregnancy, as pregnancy progresses, the size of the uterus changes. The change in the shape of the uterus is determined with a two-handed (bimanual) examination. The uterus in non-pregnant women is pear-shaped, somewhat compacted in the anteroposterior size. With the onset of pregnancy, the shape of the uterus changes. From 5-6 weeks, the uterus takes on a spherical shape. Starting from 7-8 weeks, the uterus becomes asymmetrical, one of its corners can protrude. By about 10 weeks, the uterus becomes spherical again, and by the end of pregnancy it takes on an ovoid shape.

The following signs indicate pregnancy:

Enlargement of the uterus ... The increase in the uterus is noticeable at 5-6 weeks of pregnancy; The uterus first increases in the anteroposterior direction (becomes spherical), later its transverse size also increases. The longer the gestation period, the clearer the increase in the volume of the uterus. By the end of the second month of pregnancy, the uterus increases to the size of a goose egg, at the end of the third month of pregnancy, the bottom of the uterus is at the level of the symphysis or slightly above it.

Horwitz-Gegar sign ... The consistency of the pregnant uterus is soft, and the softening is especially pronounced in the isthmus. In a two-handed study, the fingers of both hands meet in the isthmus region with almost no resistance. This symptom is very typical for early pregnancy.

Snegirev's sign ... Pregnancy is characterized by a slight change in the consistency of the uterus. The softened pregnant uterus, during a two-handed examination, becomes denser and shrinks under the influence of mechanical irritation. After the termination of irritation, the uterus regains a soft consistency.

Piskacek sign. In the early stages of pregnancy, there is often an asymmetry of the uterus, depending on the dome-shaped protrusion of its right or left corner from 7-8 weeks.

The protrusion corresponds to the site of implantation of the ovum. As the ovum grows, the protrusion gradually disappears (by 10 weeks).

Gubarev and Gaus drew attention to the easy mobility of the cervix in the early stages of pregnancy. Easy displacement of the cervix is associated with significant softening of the isthmus.

Genter's sign. In the early stages of pregnancy, there is an increased bend of the uterus anteriorly, resulting from a strong softening of the isthmus, as well as a ridge-like thickening (protrusion) on the anterior surface of the uterus along the midline. This thickening is not always determined.

Thus, the diagnosis of pregnancy is made on the basis of clinical findings. However, in some cases, when it is difficult to diagnose pregnancy or for the purpose of differential diagnosis, laboratory diagnostic methods are used. Diagnosis of early pregnancy is based on the determination of pregnancy-specific substances in the body fluids of a woman.

Modern methods for diagnosing pregnancy are divided into biological, immunological, echographic (ultrasound diagnostics) and others.

Both biological and immunological methods are based on the determination of choriogonadotropin (CG), a hormone secreted by chorion, in a biological material (most often in urine). Choriogonadotropin (CG) is chemically close to pituitary lutropin (LH), it is a glycoprotein with a relative molecular weight of 37900.

The hormone consists of two peptide chains ( and -subunits), one of which () is the same for all glycoproteins - hCG, lutropin (LH), follitropin (FSH) and thyrotropin (TSH), and the other is -specific for each of them. The-subunit of hCG with a relative molecular weight of 23,000 has a specific hormonal activity. The synthesis of hCG begins from the first days of pregnancy and continues until delivery with maximum production 60-70 days after implantation. Then its level decreases and remains stable until delivery.

Currently, immunological methods are used to diagnose early pregnancy. Immunological methods are based on a precipitation reaction with rabbit antiserum, either on complement fixation, or on inhibition of the hemagglutination reaction. The most widely used method of suppressing the hemagglutination reaction, developed simultaneously in two laboratories in 1960, Z. Swierczynska, E. Samochowiec (Poland) and L. Wide, C. Gemzell (Sweden). The method is based on inhibition of the agglutination reaction between "charged" HCG erythrocytes (antigen), anti-HCG antiserum (containing specific antibodies) and added urine. When erythrocytes, "charged" CG (antigen) and the urine of a pregnant woman, are added to the antiserum (antibodies), the CG present in it binds to the antiserum, and the erythrocytes do not agglutinate and settle to the bottom of the ampoule. If urine of a non-pregnant woman, which does not contain CG, is added, an agglutination reaction occurs, and red blood cells are distributed evenly in the ampoule. To carry out the diagnostic reaction, the contents of the ampoule are dissolved in 0.4 ml of the phosphate buffer supplied with the kit, and two drops of fresh morning filtered urine are added using the supplied capillary. The contents of the ampoule are mixed and the ampoule is placed at room temperature. After 2 hours, the reaction is taken into account: a uniform distribution of erythrocytes in the ampoule indicates the absence of pregnancy, their settling to the bottom in the form of a ring or a button indicates the presence of pregnancy.

Radioimmunological method 10 times more sensitive than immunological. The most common method of double antibodies, based on the precipitation of antibodies to a hormone. For radioimmunological determination of hCG, it is best to use ready-made kits produced by various companies. The use of radioimmunological methods makes it possible, within 5-7 days after implantation of the ovum, to determine the level of hCG, equal to 0.12-0.50 IU / L. The latest radioimmunological methods for the determination of the -subunit in the HCG molecule make it possible to determine its level equal to 3.0 IU / L. The determination time is 1.5-2.5 minutes.

Immunoassay express methods determination of hCG or -hCG in urine makes it possible to diagnose pregnancy 1-2 weeks after nidation of the ovum.

There are test systems for quickly determining the presence or absence of pregnancy, which women themselves can use.

Questions diagnosis of pregnancy worried people for a long time. To find out if a woman was pregnant in ancient Egypt, she was given a drink made from a special herb (bududu-ka) and the milk of a woman who gave birth to a boy. If this drink caused vomiting, then the woman is pregnant, otherwise there was no pregnancy. To determine pregnancy, the ancient Jews forced a woman to walk on soft grass: if there was a deep trace, then pregnancy existed.

The midwives of ancient Greece already possessed considerable knowledge. So, to determine pregnancy, they were based on a number of objective signs: absence of menstruation, lack of appetite, salivation, nausea, the appearance of yellow spots on the face. At the same time, they also resorted to such ridiculous means: a red stone was rubbed in front of the woman's eyes, and if dust got into her eyes, the woman was considered pregnant, otherwise the pregnancy was denied.

Even Hippocrates (460-377 BC) had many false and mistaken ideas about pregnancy. In particular, he believed that pregnancy could be recognized by the eyes, but at the same time, he considered the cessation of menstruation to be one of the first signs of pregnancy.

Soranus of Ephesus (1st century AD) established the following signs of pregnancy: menstruation is delayed, the mammary glands swell, and the vessels of the skin of the mammary glands become convoluted, acquire a bluish tint and swell; there is an urge to vomit; dark circles appear under the eyes, and sometimes yellow spots on the face; over time, the abdomen increases and the pregnant woman begins to feel the movements of the fetus.

According to their diagnostic value, signs of pregnancy are divided into presumptive and probable, which appear relatively early, and reliable, usually found from the second half of pregnancy. It is therefore quite understandable that it is impossible to use reliable signs for the early diagnosis of pregnancy.

Presumptive (doubtful) signs that appear early, although not with every pregnancy, but still have some diagnostic value, include the following:

Dyspeptic disorders, a feeling of heaviness in the epigastric region, salivation, nausea, morning vomiting on an empty stomach, changes in appetite or aversion to certain types of food (usually meat), the emergence of a special addiction to spicy and especially sour foods, constipation, desire to eat inedible substances lime , chalk, clay, etc.

Functional disorders of the nervous system and psyche: slight irritability, exacerbation of smell and hearing, tearfulness, withdrawal.

Changes in metabolism: deposition of subcutaneous fat, especially on the abdomen, pigmentation of the nipples and areola, the white line, and sometimes the face.

The appearance of stripes (scars) of pregnancy.

All these signs are often found in pregnant women, but are not necessarily associated with pregnancy, and therefore are called hypothetical.

Possible signs of pregnancy include the following:

Cessation of menstruation in a healthy, sexually active woman of childbearing age.

Congestion, cyanotic color of the mucous membrane of the entrance to the vagina, its walls and the vaginal part of the cervix. An increase in the size of the uterus in accordance with the period of delay in menstruation, a change in its usual shape and consistency.

Engorgement of the mammary glands and the appearance of colostrum in them.

All these signs in most cases really characterize pregnancy, but sometimes they can be the result of other reasons. For example, a delay in menstruation can be of a psychogenic nature; the cause of the enlargement of the uterus is a growing tumor. Therefore, the listed signs of pregnancy are valuable not individually, but in aggregate.

Reliable (undoubted) signs of pregnancy include the following:

Determination of parts of the fetus when feeling the uterus; it is easiest to identify the round, dense part of the head, as well as the small parts of the handle and leg.
Stirring of the fetus, determined by the examiner's hand.
Listening to the fetal heartbeat with a stethoscope or with a heart rate monitor.

These signs 100% certify pregnancy, but they are late, since they can be noted only from the end of the 4th or beginning of the 5th month of pregnancy. One of the important points in the diagnosis of pregnancy is a vaginal examination and palpation of the uterus, so this should be discussed in more detail. The size of a normal non-pregnant uterus along the longitudinal axis is approximately 79 cm (in non-pregnant women, somewhat less, in those who have given birth, somewhat more). With the onset of pregnancy and in the process of its development, the size of the uterus increases. Until the end of the third month of pregnancy, the uterus is still in the pelvic cavity and can only be felt during vaginal examination. Only after this period, no longer fitting in the small pelvis, the uterus leaves it and can be felt from the side of the abdominal wall, and subsequently leads to a noticeable increase in the abdomen.

A normal non-pregnant uterus is usually pear-shaped, somewhat flattened anteroposteriorly. With the onset of pregnancy, in the process of its further development, the shape of the uterus changes. At first, it takes a spherical shape, then somewhat asymmetric, then again spherical and by the end of pregnancy it is ovoid.

Acquisition by the uterus of a spherical shape, along with other signs, is very characteristic of pregnancy. The spherical shape of the uterus can be noted already from 5 to 6 weeks of pregnancy, and this shape can persist up to about 9 to 10 weeks.

Starting from 78 weeks of pregnancy, the uterus becomes asymmetrical, namely: one of its corners protrudes somewhat, as if bulging in comparison with the opposite side. The appearance of asymmetry is due to the fact that the implantation of a fertilized egg in the uterine cavity usually occurs near the mouth of the tube through which the egg was transported. This feature of the shape of the uterus during the indicated period of pregnancy was first noted by Piscacek and proposed by him as a diagnostic feature (see Fig.). In the future, with the development of pregnancy, the asymmetry of the body of the uterus disappears, and then the Piskachek symptom will no longer be determined.

The consistency changes with the onset of pregnancy: it becomes much softer. Softening of the uterus occurs due to an increase in the size and number of muscle fibers due to the enrichment of the organ with blood, stagnation. Particular softening is noted in the area of the isthmus of the uterus (see fig).

Sometimes the softening is so pronounced that when examined, the body of the uterus appears to be separated from the cervix. The second feature of the pregnant uterus is the inconstancy of its consistency. When examining a pregnant uterus, at first, its softish consistency is noted, and in the process of research, the uterus becomes denser. Such a change in the uterus at the time of examination is a particularly characteristic sign for pregnancy.

It is not always possible to diagnose a very early pregnancy with an internal obstetric examination, since the main signs of pregnancy obtained in this case can be detected no earlier than 56 weeks of pregnancy. Before this period, pregnancy does not yet lead to tangible changes in the uterus. Even with a longer period, sometimes complete confidence in the accuracy of the data obtained is not created. Meanwhile, it is often required to establish the presence of pregnancy before 5 weeks, for example, for the production of a mini-abortion.

Methods for determining pregnancy

The imperfection of the palpation method for early diagnosis of pregnancy has long directed the idea of finding other methods based on identifying those changes in a woman's body that occur with the onset of pregnancy.

The study of biochemical changes occurring in the body of a pregnant woman made it possible to propose various reactions with the help of which they tried to diagnose pregnancy. The evolution of these methods was quite long and continues to this day. At the same time, the methods were improved in parallel with the development of science and the emergence of new knowledge, and particular successes are associated with the development of biochemistry and immunology. All methods are based on the detection in the blood or urine of a woman of the pregnancy hormone - chorionic gonadotropin. This substance is found in a woman's blood by modern techniques within a week after conception.

The most widespread is the rapid diagnosis of pregnancy using test systems, which are based on the principle of chromatography. The sensitivity of the test is sufficient for almost 100% accurate diagnosis of pregnancy on the 1st day of the delay in the expected menstruation, and often it is possible and 3-5 days earlier than the delay. With the help of such a test, in many cases, an ectopic pregnancy is also detected, however, it is impossible to distinguish it from a uterine pregnancy on the basis of this test alone.

Now on sale there are various diagnostic tests that allow you to independently identify the presence of pregnancy at home. Most often, such a test is a test strip immersed in urine for 1-2 minutes. The presence of pregnancy is judged by the number of colored stripes.

With the help of an enzyme-linked immunosorbent assay, you can accurately determine the amount of human chorionic gonadotropin in the blood. But for the diagnosis of pregnancy, this method is usually not used, since there is no need. But in some cases, such a definition is of practical importance. For example, to monitor the nature of the course of pregnancy, diagnose trophoblastic disease, ectopic pregnancy.

Another well-known and affordable method for diagnosing early pregnancy is ultrasound (ultrasound). It allows you to detect pregnancy about 5-6 days of delayed menstruation. When viewed with a special transvaginal sensor (which is inserted into the vagina), this can be done 1-3 days earlier. During these periods, an ultrasound scan can see a fetal egg with a diameter of 4-6 mm in the uterus.

Thus, at present, the diagnosis of pregnancy does not present any particular difficulties for a specialist and can be very early.

A. Sh. Makhmutkhodzhaev,
Obstetrician-gynecologist, assistant of the Department of Obstetrics and Gynecology, Siberian State Medical University.
Based on materials