With the advent of ultrasound and specific urine and blood tests, the diagnosis of pregnancy today is pretty much a “no-brainer.” In the “olden times,” circa 1960, doctors used a combination of judgment and diagnostic tools that today seem prehistoric. Nevertheless, there is a certain charm in the way pregnancy was diagnosed before the advent of modern aids.

Although the science of obstetrics has made for a better pregnancy, the beauty of the art of medicine has been somewhat lost. Today we can clinically pinpoint ovulation and conception. We can use ultrasound to take pictures of the baby and can track rising hCG titers almost before the period is late. But it wasn’t too, too long ago that women couldn't get an official diagnosis until mid-pregnancy. In the early stages of pregnancy, obstetricians and their patients relied upon these three main signs and symptoms to diagnose pregnancy:

1. Presumptive Evidence
A woman suspects she is pregnant based upon the following perceptions:

• Lack of menstruation. Other things can cause this, but pregnancy and menopause top the list of possibilities.



• Breast changes. Breasts are tender early on; later the nipples become darkened and enlarged. Later still, there is colostrum discharge (a precursor to milk).



• Chadwick’s sign. This old-fashioned term refers to a bluish discoloration of the vaginal tissue, caused by venous congestion in the area.



• Abdominal striae, affectionately known as "stretch marks."



• Increased pigmentation. The "linea nigra," or black line, runs up the center of the woman’s abdomen and usually fades after pregnancy.



• Nausea.



• Increase in urination, due to the pressure of the growing uterus on the bladder.



• Fatigue.



• "Quickening", an elegant and old-fashioned term associated with the thrilling perception of movement between 16 and 20 weeks.

2. Probable Evidence of Pregnancy
An examiner determines that the patient is likely pregnant based on these symptoms:

• Enlargement of the abdomen, presumably due to increase in size of the uterus. The uterus can usually be felt through the abdomen after 12 weeks. This sign is more obvious in the abdomens that have been "pre-stretched" with a previous pregnancy.



• Changes in the size, shape, and consistency of the uterus. "Hegar's Sign" is when the uterus becomes so soft, usually at 6 weeks that it is felt separately from the firmer cervix. Softening of the cervix usually occurs at about the same time. This occurrence is called "Goodell's Sign."



• Braxton Hicks'Contractions. These are irregular and unorganized contractions of the uterus.



• Ballottement. This is a mid-pregnancy sign in which the fetus can be pushed from the mother's abdomen and felt to bounce back.

3. Positive Signs of Pregnancy (F'sure!)

• Identification of the fetal heart beat separate and distinct from that of the mother. Distinguishing the two can be done by taking the mother’s pulse while listening to the fetal heart.



• An examiner hearing blood swishing through the umbilical cord, (the "funic") is as meaningful as hearing the actual fetal heart. On the other hand, blood passing through the dilated uterine blood vessels, (the "uterine soufflé") is associated with the maternal pulse.



• Perception of fetal movement by the examiner.



• 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, quaint and of historical interest only. Yet I get many questions every day in which a woman cites this symptom or that and then asks, "Can I be pregnant?" Depending on which of the three groups a woman can identify with, she will at least have an answer of some sort, whether it be "Maybe," "Probably," or "Most Definitely!"