Pregnancy Testing Then and Now

With the advent of ultrasound and specific urine and blood tests, the diagnosis of pregnancy is pretty much a no-brainer for today's physician. But in the history of pregnancy diagnosis, before these modern aids were in common use, doctors were trained differently, using judgment and diagnostic skills that would today seem obsolete. Today we can clinically pinpoint ovulation and conception, so current obstetrical books do not dwell on the diagnostic measures that relied on the signs and symptoms of yesteryear.

But yesteryear's books, incorporating the intrigue and romance of physiologic processes, were so beautifully written that it's hard for me to ever throw any of them away. (The "pack-rat" syndrome comes from a gene firmly rooted in the Y-chromosome.) Looking through them takes me on a journey into the wonders of the art of diagnosis; and back to when the early diagnosis of pregnancy was such an art that there was a certain bonding phenomenon that developed with the tracking of pregnancy. 

Today you're handed ultrasound pictures of your baby. In earlier, less technologically 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.

While we should never pine for a return to those days, it's fun to look at diagnosis through the eyes of old-time medicine. In spite of the clinical importance of where we are today, pregnancy is and has always been a beautiful mammalian experience; and although the science of obstetrics has made for a better 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" diagnostics were grouped into three classifications: Presumptive, probable, and positive evidence of pregnancy.

Presumptive Evidence of Pregnancy

This category comprises mainly things you yourself notice:

• Cessation of menses: Your period stops. Other things can cause this, but pregnancy and menopause top the list of possibilities.
• 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: Also known as "stretch marks."
• Increased pigmentation: The "linea nigra," or black line, runs up the center of the abdomen and usually fades after pregnancy.
• Nausea
• Increase in urination: This is due to the pressure of the growing uterus on the bladder. The bladder is a rather stupid organ and can't tell whether the pressure it should respond to is coming from inside (as in urine) or outside (the enlarging uterus).
• Fatigue
• 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.

This category comprises what your doctor will notice:

• Enlargement of the abdomen: This is presumably due to increase in size of the uterus. The uterus can usually be felt through the abdomen after 12 weeks. This sign will be obvious earlier in the abdomens that have been stretched out before with a previous pregnancy. Into the second trimester, an actual measurement called the fundal height can be recorded each visit.
• Changes in the size, shape, and consistency of the uterus: "Hegar's Sign" is when the uterus becomes so soft, usually at six 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." The increase in size, as described above, is part of the total package change.
• Braxton Hicks' Contractions: The irregular and unorganized contractions of the uterus.
• Ballottement: A mid-pregnancy sign in which the fetus can be pushed from your abdomen and felt to bounce back, tapping your doctor's examining finger in the vagina. Obstetricians never use this technique anymore to diagnose pregnancy.

Positive Signs of Pregnancy

This category includes laboratory and other empirical evidence scientifically shown to indicate a pregnancy.

• Identification of the fetal heartbeat separately and distinctly from that of the mother. Hearing the heartbeat 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 "soufflé") is as meaningful as hearing the actual fetal heart, because it's the fetal heart's beating that causes the umbilical cord to pulsate. On the other hand, blood passing through the dilated uterine blood vessels, the "uterine soufflé," is associated with the maternal pulse, driven by your own heart.
• 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 and quaint. 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?" Depending on which of three groups you identify with, your answer will be "Maybe," "Probably," or "Definitely."