Diagnosis & differential diagnosis of pregnancy

Introduction

It is advantageous to diagnose pregnancy as promptly as possible when a sexually active woman misses a menstrual period or has symptoms suggestive of pregnancy. In the event of a desired pregnancy, prenatal care can begin early, and potentially harmful medications and activities such as drug and alcohol use, smoking, and occupational chemical exposure can be halted. In the event of an unwanted pregnancy, counseling about adoption or termination of the pregnancy can be provided at an early stage.

 

Pregnancy Tests

All urine or blood pregnancy tests rely on the detection of hCG produced by the placenta. hCG levels increase shortly after implantation, approximately double every 48 hours, reach a peak at 50-75 days, and fall to lower levels in the second and third trimesters. Laboratory and home pregnancy tests use monoclonal antibodies specific for hCG. These tests are performed on serum or urine and are accurate at the time of the missed period or shortly after it.

Compared with intrauterine pregnancies, ectopic pregnancies may show lower levels of hCG that level off or fall in serial determinations. Quantitative assays of hCG repeated at 48- to 72-hour intervals are used in the diagnosis of ectopic pregnancy as well as in cases of molar pregnancy, threatened abortion, and missed abortion. Comparison of hCG levels between laboratories may be misleading in a given patient because different international standards may produce results that vary by as much as twofold.

Manifestations of Pregnancy

The following symptoms and signs are usually due to pregnancy, but none are diagnostic. A record of the time and frequency of coitus is helpful for diagnosing and dating a pregnancy.

A. Symptoms
Amenorrhea, nausea and vomiting, breast tenderness and tingling, urinary frequency and urgency, “quickening” (perception of first movement noted at about the 18th week), weight gain.

B. Signs (in Weeks From LMP)
Breast changes (enlargement, vascular engorgement, colostrum), abdominal enlargement, cyanosis of vagina and cervical portio (about the seventh week), softening of the cervix (seventh week), softening of the cervicouterine junction (eighth week), generalized enlargement and diffuse softening of the corpus (after eighth week).

The uterine fundus is palpable above the pubic symphysis by 12-15 weeks from the LMP and reaches the umbilicus by 20-22 weeks. Fetal heart tones can be heard by Doppler at 10-12 weeks of gestation and at 20 weeks with an ordinary fetoscope.

Differential Diagnosis

The nonpregnant uterus enlarged by myomas can be confused with the gravid uterus, but it is usually very firm and irregular. An ovarian tumor may be found midline, displacing the nonpregnant uterus to the side or posteriorly. Ultrasonography and a pregnancy test will provide accurate diagnosis in these circumstances.

Provided by ArmMed Media
Revision date: June 21, 2011
Last revised: by Janet A. Staessen, MD, PhD