Pregnancy is one of the most commonly misdiagnosed conditions in medical practice. The answer to “Am I really Pregnant?” is best answered by more than one test. Some women who think they are pregnant are not, while others go through haIf a pregnancy (or more!) before they realize what is happening. Doctors diagnose pregnancy when it is not present, or fail to diagnose it when the patient’s symptoms suggest other conditions! The possibilities for error are enormous. Yet, for the vast majority of women, the diagnosis is perfectly straightforward.
SIGNS AND SYMPTOMS OF PREGNANCY
For a woman who usually has a normal regular menstrual cycle, a missed period is the most important and reliable symptom of pregnancy. If the periods are usually irregular, however, it may be a while before the absence of periods is noticed. By this time, other symptoms will be drawing attention to the situation.
The answer to whether or not a woman can have normal periods when pregnant is no. Any woman who is having normal regular periods is not pregnant. Slight bleeding may occur at intervals during the first three months of pregnancy, but this is not the same as haying a period, and is best regarded and treated as a threatened. Heavier bleeding should certainly be so treated. Women who claim that they have ‘normal periods’ when pregnant have usually had a repeated threatened miscarriage which has cleared up and allowed the pregnancy to continue normally.
Enlarged, tender breasts
The breasts often become a little enlarged and tender before a period is due; these breast changes are even more noticeable as soon as pregnancy occurs and the first period is missed. Once the pregnancy is fully established it is usually possible to express a yellow fluid called colostrum from the nipples.
Most but not all pregnant women suffer from some degree of nausea in early pregnancy which may make them vomit. Early morning sickness is a traditional pregnancy symptom, but in reality the nausea and vomiting may occur at any time of the day.
Early pregnancy is often associated with a feeling of fatigue and a desire to sleep for longer periods than usual. The answer is to give the body what it needs – rest.
In early pregnancy the enlarging uterus presses on the bladder and the result is more frequent trips to the lavatory! The pregnant woman also drinks more to quench an increased thirst, and this, too, makes for a greater production of urine.
A slight white vaginal discharge, which does not cause any local soreness or irritation, is not due to any infection in the vagina. It results from an increase in the normal vaginal secretions.
During first pregnancy, the skin on the nipples turns brown because of an increase in the amount of brown pigment. Although the brown colour fades after the pregnancy is over, it never goes completely. As well as changing colour, the small lubricating glands around the nipple increase in size and can be seen as small projections from the surface of the skin. These are known as Montgomery’s tubercles, named after the doctor who first described them.
Pigmentation also occurs in a thin line stretching from the pubic bone to the lower find of the breast bone (sternum). This dark line (linea nigra) is more obvious between pubis and navel. Pigmentation of the face around the eyes, on the cheeks and forehead, is usually present to some degree in most women, but it is not usually very noticeable.
Occasionally it is very prominent and the mother-to-be may look as though she is wearing a mask – the so-called mask of pregnancy. Both abdominal and facial pigmentation fade once the pregnancy is over.
If a woman thinks she may be pregnant she should, of course, consult her doctor. He will usually want to confirm whether or not she is pregnant by doing an examination to see if the uterus (womb) is enlarged. In the early stages of pregnancy this can only be done by a vaginal examination.
Many women dread the thought of a vaginal or internal examination. The idea that the doctor is going to insert his fingers into the vagina is, for some women, very upsetting and embarrassing. It is, however, a simple examination which is usually painless and, at worst, only slightly uncomfortable. For the doctor it is as normal a part of his routine as, for example, looking into the ear of a patient with earache. It is very important to be relaxed because if the pelvic and abdominal muscles are tense the examination is much more difficult for the doctor and much more likely to be painful for the patient. If you find you are becoming tense, breathe slowly and steadily with your mouth open. This will help to keep the relevant muscles relaxed.
The examination may be carried out with the woman lying on her back with her knees drawn up, or lying curled up on her left side. The doctor will put on a plastic glove and insert one or two lingers gently into the vagina to feel the womb. At the same time, he will press his other hand gently on the lower part of the woman’s abdomen.
To the experienced doctor, the enlarged soft uterus of pregnancy is easily detectable by about six to eight weeks after the last menstrual period. By estimating the size of the uterus, the doctor can also give an expected date of delivery. The examination is more easily conducted in thin women than in overweight women. In the latter, the uterus may not be easy to feel in early pregnancy. Provided the patient relaxes completely, however, a confident diagnosis can usually be made by eight weeks even in the plumpest ladies.
The Pregnancy Test
The change that takes place in a woman’swhen she becomes pregnant provides an easy reliable method of pregnancy testing. The particular hormone that is used for this purpose at the present time is called gonadotrophin. Six weeks from the first day of the last menstrual period, or approximately four weeks after conception has occurred, this appears in the urine in sufficient quantity to be detected. The test can be performed on any clean specimen of urine, but a specimen taken from the first urine passed in the morning gives the most reliable results.
Although the actual performance of the tests is simple, reading the result, especially in the very early stages of pregnancy, can be more difficult. For this reason the test is best done by someone with experience. The local hospital laboratory is usually the most reliable place to have a pregnancy test performed, but many reputable chemists offer a reasonable pregnancy testing service, as do the larger pregnancy advisory services.
Do-it-yourself kits are best avoided if other testing facilities are available. Unfortunately it is in the very early days of pregnancy that test results are least reliable and this can lead to much unnecessary confusion and distress. A test which shows a woman to be pregnant when she is not sometimes arises in women approaching the menopause. This is because the hormonal changes of menopause are similar in some ways to those of early pregnancy. A test which shows the woman not to be pregnant when she is, is most likely to occur in very early pregnancy, between six to eight weeks after the first day of the last menstrual period.
Listening to the Baby’s Heart
Once twelve weeks have passed from the first day of the last period, the top of the uterus can be felt in the lower part of the abdomen just above the pubic bone. Feeling the enlarged uterus is, in itself, a good way to diagnose pregnancy, but by using an ultrasonic fetal heart detector the baby’s heartbeat can be demonstrated. This provides the most dramatic evidence of all that not only is the woman pregnant, but that the baby is alive and ‘ticking’!
A more complicated ultrasonic machine can be used to diagnose pregnancy from a very early stage, but this sort of ultrasound examination will normally only be carried out at this stage of pregnancy if the other diagnostic measures are inconclusive.
X-rays are rarely used nowadays to diagnose pregnancy. The baby only shows up on the X-ray after sixteen weeks and by this time the diagnosis is usually obvious by other symptoms and signs. Occasionally a pregnant woman is X-rayed as part of an investigation into other diseases and the baby shows up on the X-ray picture as a surprise intruder!
In well-run X-ray departments this will never happen because the radiologist will make quite sure that every woman who is X-rayed is not pregnant. The reason for this is that there is a very slight risk to the baby if an X-ray of the mother’s abdomen is taken in early pregnancy. The best general rule is that a woman who needs an X-ray of the lower abdomen or pelvis should only have it taken in the first ten days of the menstrual cycle. In this way there will be little risk of X-raying an unsuspected early pregnancy.