THE DIAGNOSIS OF PREGNANCY

The medical diagnosis of pregnancy serves as to date the expected birth and helps predict the
existence of a high risk status. It also marks a major life milestone. If the pregnancy was planned, the
diagnosis produces a feeling of intense fulfillment and achievement; if it wasn’t desired it can result in an
equally extreme crisis state.

From the day the pregnancy is confirmed, most women eat a nutritious diet, give up smoking and
alcohol ingestion and stop taking non-essential medications. Because a woman may not take these
measures before the confirmation of pregnancy, this makes early confirmation of pregnancy important. If
the woman does not wish to continue the pregnancy, early diagnosis is also imperative, elective
termination of pregnancy always should be carried in the earliest stage possible for the safest outcome.

If a sexually active woman is scheduled for diagnostic testing that includes a pelvic x-ray study
such as an intravenous pyelogram for kidney disease, you might suggest that she first have a rapid serum
pregnancy test to rule out pregnancy as a possibility, to avoid exposing the fetus in radiation.

Most women who come to a health care facility for a diagnosis of pregnancy have already
guessed that they are pregnant based on a multitude of presumptive signs. Most have already done a
pregnancy test at their homes to confirm the pregnancy for themselves.

Pregnancy is officially diagnosed on the basis of symptoms reported by the woman and the signs
elicited by the health care provider. These signs and symptoms are traditionally divided into three
classifications: presumptive, probable and positive.

PRESUMPTIVE SIGNS
* are those that are least indicative of pregnancy, they could easily indicate other conditions
* largely subjective (they are experienced by the woman but cannot be documented by the examiner)

Morning sickness
Amenorrhea
Changes in breast
Fatigue
Lassitude
Urinary frequency
Quickening (18 – 20 th
weeks)

PROBABLE SIGNS
* can be documented by the examiner
* more reliable than presumptive signs (but still, they are not true diagnostic findings)
Chadwicks – blusih discoloration of vaginal wall
Hegar – softening of lower uterine segment
Uerine enlargement – at 12 weeks gestation, felt just above the symphysis pubis
Positive pregnancy test – presence of gonadotrophin in urine; (as little as 35 mIU/mL)
Ballottment – sinking and rebound of fetus
Outlining of fetal body
Goodells – pronounced softening and cyanosis of cervix
Souffle, contraction and Braxton Hicks (painless contraction at 28 weeks)

POSITIVE SIGNS
* these are the definitive signs of pregnancy
* there are only three positive signs of pregnancy:

heartbeat (10 wks by Doppler, 16 wks by fetoscope, 18-20 wks by

ausculatation)
movement – felt by the examiner usually after 20weeks
skeleton by sonography or x-ray

A Report Facilitated by:

BUSA, Merla S.
BS Nursing IV - 1

References:
Maternal And Child Health Nursing 5th Edition by Adele Pilliteri
Ultimate Learning Guide 2008 Edition by Carlito E. Balita
QUIZ:
1. Physiologic changes of pregnancy targets the GIT system as well. At the same time when hCG
and progesterone begin to rise, patient Julberry Adams begins to experience nausea and vomiting.
Having been acquainted with the diagnosis of pregnancy, identify what particular sign is
demonstrated and to what classification do this sign falls under.
2. Upon examination, you have noted that patient Lauren Maxwell have a pronounced softening and
cyanosis of the cervix. Being a nurse, you have classified this observation under presumptive
signs of pregnancy. Identify one reason among the four mentioned in the report why this certain
sign becomes visible.
3. Based on patient Sandra Czarinski’s LMP, you have computed that today is her 19 th week of
gestation. Identify what medical apparatus will you utilize during this time to come up with a
demonstration of a fetal heart separate from the mother’s which corresponds to the only three
positive signs of pregnancy.
4. Now, women can diagnose their pregnancies at home by means of a test kit. Cheryl Carl have
told you that she is taking monophasic COC’s. You aim not to come up with a false – positive
result therefore, identify the period that the patient needs to discontinue COC’s prior the test.
5. A probable sign of pregnancy which serves as a warm-up exercise for labor and also increases
placental perfusion is the so called Braxton Hicks contractions. These may become so strong and
noticeable in the last months of pregnancy that they are mistaken for labor contractions. Identify
what you will be aware of then to differentiate these contractions from true labor contractions
when performing internal examination.

ANSWERS
1. Morning sickness
2. Increased vascularity, edema, hypertrophy and hyperplasia of cervical glands
3. Stethoscope
4. 5 days
5. No cervical dilatation noted