The Womb of the Unknown Pregnancy
The Art of Classical Obstetrics
With the advent of ultrasound and specific urine and blood tests, the diagnosis of pregnancy is pretty much a no-brainer. But there is a certain romance of sorts in the history of pregnancy diagnosis before these modern aids were in common use. Doctors used to be trained differently, using judgement and diagnostic skills that would today seem obsolete. Today we can clinically pin-point ovulation and conception, so current obstetrical books do not dwell on the diagnostic measures that relied on the signs and symptoms of yesteryear.
Back when the early diagnosis of pregnancy was an art, there was a certain bonding phenomenon that occured with the tracking of the conditions described below. Today we're handed ultrasound pictures of baby on a silver platter before Chadwick or Goodell (see below) could ever enter the picture, and we're spoon-fed rising hCG titers almost before the period is late. In earlier non-sophisticated times, many women couldn't get the diagnosis of their "delicate condition" until mid-pregnancy.The signs and symptoms described below were in fact the practice of medicine back then, but now most of them are of historical significance only.
In spite of the clinical importance, however, pregnancy is a beautiful mammalian experience; and although the science of obstetrics has made for better a pregnancy, the beauty of the art of medicine has been somewhat lost.
Back in the "olden times," circa 1960 (last century, remember?), the "old time" diagnotics were grouped into three classifications:
Presumptive Evidence of Pregnancy--mainly things perceived by the woman:
- Cessation of menses--the period stops. Other things can cause this, but pregnancy and menopause top the list of possiblilies.
- Changes in the breasts--tenderness early on, then later the nipples becoming darker and larger. Later on, colostrum discharge (milk precursor).
- Chadwick's sign--this is an old term meaning a bluish discoloration of the vaginal tissue, caused by venous congestion in the area.
- Abdominal striae--known as "stretch marks."
- Increased pigmentation. The "linea nigra," or black line, runs up thecenter of the abdomen and usually fades after pregnancy.
- Increase in urination, due to the pressure of the growing uterus on the bladder.
- Quickening--the woman's perception of movement between 16 and 20 weeks. "Quickening" is an elegant and old-fashioned term associated with the perception of life--a thrill of a Creationist flavor.
Probable Evidence of Pregnancy--as determined by an examiner:
- Enlargement of the abdomen, presumably due to increase in size of the uterus. The uterus can usually be felt through the abdomen after 12 weeks. This sign is more obvious in the abdomens that have been stretched out before with a previous pregnancy.
- Changes in the size, shape, and consistency of the uterus. "Hegar's Sign" is when the uterus becomes so soft, usually at 6 weeks, that it is felt separately from the firmer cervix. Softening of the cervix usually occurs at about the same time, called "Goodell's Sign."
- Braxton Hicks' Contractions--the irregular and unorganized contractions of the uterus.
- Ballottement--a mid-pregnancy sign in which the fetus can be pushed from the mother's abdomen, and felt to bounce back, tapping an examining finger in the vagina.
Positive signs of pregnancy:
- Identification of the fetal heart beat separately and distinctly from that of the mother--hearing the heart beat can be distinguished from the mother's by simply taking her pulse while listening to the fetal heart. An examiner hearing blood swishing through the umbilical cord, (the "funic" or umbilical cord "souffle") is as meaningful as hearing the actual fetal heart. On the other hand, blood passing through the dilated uterine blood vessels, the "uterine souffle," is associated with the maternal pulse.
- Perception of fetal movement by the examiner; and
- Recognition of the fetus by X-ray or ultrasound.
Of course, modern diagnostic techniques make a lot of the "presumptive" and "probable" signs and symptoms obsolete, quaint, and of an historical interest only. Yet I get many questions every day in which a woman cites this symptom or that and then asks, "Can I be pregnant?" It is for these hopefuls that I answered the question, "What are the signs of pregnancy?" Which of three groups a woman can identify with will yield the answer, "Maybe," "Probably," or "Definitely."