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Lecture notes, cheat sheets
Obstetrics and gynecology. Diagnosis of pregnancy (lecture notes)
Directory / Lecture notes, cheat sheets Table of contents (expand) Lecture number 3. Diagnosis of pregnancy Diagnosis of early pregnancy is made on the basis of the identification of presumptive (doubtful) and probable signs of pregnancy. 1. Alleged (doubtful) signs Associated with general changes in the body of a pregnant woman. There is a change in appetite and taste, smell, nausea, sometimes vomiting in the morning, weakness, malaise, irritability, tearfulness. The same signs include the appearance of skin pigmentation on the face, along the white line of the abdomen, in the nipples and external genitalia. 2. Possible signs of pregnancy These are objective changes that are found on the part of the female genital organs, mammary glands, or are detected during pregnancy tests. Probable signs can appear both during pregnancy and independently. These signs include the cessation of menstrual function in women of childbearing age, an increase in the mammary glands and the release of colostrum from them when pressed, a cyanotic color of the mucous membrane of the vagina and cervix, an increase in the uterus. Early pregnancy is characterized by certain signs. 1. An increase in the uterus becomes noticeable from the 5-6th week. At the end of the 2nd month, the size of the uterus reaches the size of a goose egg. By the end of the 3rd month, the bottom of the uterus is determined at the level of the upper edge of the symphysis. 2. Horvitz-Gegar sign - the appearance of softening in the isthmus. 3. Snegirev's sign - a change in the consistency of the uterus during its palpation (after the study, the uterus becomes denser). 4. Sign of Piskachek - bulging of one of the corners of the uterus associated with the development of the fetal egg. 5. Genter's sign - a ridge-like protrusion is felt on the anterior surface of the uterus along the midline. Diagnosis of late pregnancy is based on the registration of reliable signs, such as: fetal movement, listening to fetal heart sounds, probing parts of the fetus, X-ray and ultrasound examination data. Biological and immunological methods for diagnosing pregnancy Ashheim-Zondeka reaction With the onset of pregnancy, a large amount of chorionic gonadotropin appears in the urine of a woman, the excretion of which reaches a maximum at the 8-11th week of pregnancy. This hormone can be detected in the urine from the 2nd day after implantation. For research take the morning portion of urine. With an alkaline or neutral reaction, the urine is slightly acidified with acetic acid and filtered. Urine is administered to several (5) immature mice weighing 6-8 g: the first in the amount of 0,2 ml, the second - 0,25 ml, the third and fourth - 0,3 ml each, the fifth - 0,4 ml. On the 1st day, urine is administered 2 times - in the morning and in the evening, on the 2nd day - 3 times (morning, afternoon and evening) and on the 3rd day - 1 time. Thus, a total of 1,2-2,2 ml of urine is injected subcutaneously. After 96-100 hours from the moment of the first injection of urine, mice are slaughtered, the genitals are opened and examined. Depending on the data obtained, three reactions are distinguished. The first reaction: several maturing follicles are detected in the ovaries, the uterine horns are cyanotic. Such a response is doubtful. The second reaction: in the ovaries, multiple hemorrhages are found in the follicles - blood points; the reaction is specific to pregnancy. The third reaction: in the ovaries, atretic corpus luteum (luteinization of the follicles), uterine horns are found without any special changes; the reaction is specific to pregnancy. The reliability of the reaction reaches 98%. Sperm (spermatouric) Galli-Mainini reaction It is carried out on male lake frogs. It is based on the fact that frogs, outside the natural period of their reproduction, never have spermatozoa in the contents of the cloaca. Before injecting urine into a pregnant woman, the contents of the frog's cloaca should be obtained and examined to rule out the possibility of spontaneous spermatorrhea. 30-60-90 minutes after the introduction of 3-5 ml of the urine of a pregnant woman into the lymphatic sac located under the skin of the back, a large number of spermatozoa appear in the frog's cloacal fluid. They are obtained using a glass capillary pipette and examined under a microscope. The reaction accuracy ranges from 85 to 100%. Friedman reaction To diagnose pregnancy, a sexually mature rabbit at the age of 3-5 months weighing from 900 to 1500 g is used. Due to the fact that ovulation in rabbits does not occur spontaneously, but 10 hours after mating, the female and male should be kept in separate cages. In the ear vein of a sexually mature female rabbit, 6 ml of urine taken from the examined woman is injected 2 times within 4 days. 48-72 hours after the last injection under ether anesthesia, observing the rules of asepsis, the abdominal cavity is opened and the genitals are examined. With a positive reaction in the ovaries and uterus, changes similar to those found in mice are observed. The surgical wound of the abdominal wall of the rabbit is sutured in the usual way. After 6-8 weeks with a positive reaction and after 4 weeks with a negative reaction, the rabbit can be taken for re-examination. The reaction accuracy is 98-99%. Immunological research methods are based on the detection of human chorionic gonadotropin in the urine of the examined woman. They are used to diagnose early pregnancy along with biological reactions. The advantage of serological tests is their rather high specificity, speed and relative ease of implementation. The use of immunological tests virtually eliminates false positive results associated with the use of hormonal drugs. These tests are highly accurate (up to 98-99% positive), make it possible to detect small amounts of human chorionic gonadotropin, which is especially important in diagnosing early pregnancy. Author: Ilyin A.A. << Back: Pregnancy is physiological (Fertilization and development of the fertilized egg. Changes in a woman’s body during pregnancy) >> Forward: Signs of fetal maturity, the size of the head and body of a mature fetus
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