PREGNANCY DIAGNOSIS

In a woman’s life, the diagnosis of pregnancy is the one that causes the most intense emotions: from joy and sensation of wellness to deep sadness and feeling of helplessness. Any doctor assisting women at reproductive age must always ask themselves: is she pregnant? The failure in identifying pregnancy often leads to unsuitable diagnoses and treatments.

It’s important that the doctor diagnose pregnancy early. Once the diagnosis is confirmed, the pregnant woman must start prenatal care, and potential noxious agents for the binomial mother-fetus will be interrupted (medications, consumption of alcoholic drinks, smoking, handling of some chemicals, etc).

Pregnancy signs and symptoms

Menstrual delay is the finding that most often raises suspicions of pregnancy. The absence of predicted menses is the 1st clue for the presence of pregnancy. However, patients with irregular menses often suspect they’re pregnant only when other symptoms appear, such as nausea, vomit, augmentation and pain in the breast, increased urinary frequency, weight gain, augmented abdomen, and, later on, sensation of fetal movements.

At the examination of women with menstrual delay, some signs are highly suggestive of pregnancy: increase in uterine size and softening of the uterus at touch.

When there are clinical suspicions of pregnancy, laboratory tests are requested for pregnancy detection, such as human chorionic gonadotropin (hCG).

Pregnancy tests

All used pregnancy tests aim at identifying the hCG produced soon after fecundation and ovule implantation in the womb. The determination of this test in urine or blood is the most widely used method for early diagnosis of pregnancy. The production of hCG is a signal the embryo releases into the bloodstream for the body to recognize pregnancy.

HCG levels in normal pregnancy can be controlled shortly after ovule implantation. They increase by at least 66% every 48 hours, arriving at the maximum peak between 50 and 75 days of pregnancy. In the second and third pregnancy trimesters, the levels are lower. The presence of hCG in the bloodstream makes pregnancy diagnosis quite likely; however, certainty of diagnosis requires some of the following 3 positive signs of pregnancy:
 

	Presence of fetal heartbeat This can be identified by a device called sonar from 10-12 pregnancy weeks and with a stethoscope at 17 to 19 weeks. We must be careful enough during auscultation for not confusing the fetus’s heartbeat with the mother’s. Fetal heartbeat is between 120 and 160 beats per minute, and the mother’s heart rate is well lower.
	Identification of fetal movements by the doctor After the 12th pregnancy week, fetal movements can be felt by the examiner on placing their hand on the mother’s womb. When the pregnant mother is obese, perception of fetal movements happens later.
	Fetus viewing The identification of the fetus can be carried out via transvaginal echography (from the 6th pregnancy week) or through the abdomen (from the 8th pregnancy wk.). Before the existence of echography, the visualization of the fetus could only be achieved from the 16th pregnancy week by X ray, when the calcification of fetal skeleton takes place. Transvaginal echography is widely employed for the early diagnosis of pregnancy, as well as its abnormalities.

The pregnancy diagnosis isn’t hard to be confirmed, depending basically on the doctor and patient cogitating the possibility. It’s common to run into patients who underwent investigation of the gastrointestinal tract for food intolerance, nausea and vomit when in reality these symptoms were related with the unconsidered beginning of a pregnancy.

The differential diagnosis of pregnancy must be performed whenever some clinical signs and symptoms are present: almost all menstrual disorders, gastrointestinal symptoms – abdominal pain, colic, nausea, vomit, lack of or increased appetite, intolerance to some foods, increased need of sleep, mood disorders, weight gain or loss, increase in abdominal size, breast hypersensitivity, abdominal and pelvic pains, vaginal discharge, increased urinary frequency, nocturia, etc.

In most situations, carefully performed anamnesis and a careful clinical gynecological exam rule out or support the pregnancy diagnosis. However, whenever a diagnostic doubt exists, hCG levels and/or the performance of transvaginal echography mustn’t be set aside.