SIGNS AND DIAGNOSIS OF PREGNANCY.
The first and most important of all is the suppression of the menses, but it is only of value in women who are usually very regular in their monthy periods. In a certain number of females there occurs during the first months of piegnancy a sangnineous flow, but it is never just like an ordinary menstruation. It varies from it always in quantity or in quality, and if its appearance sometimes falls at the usual catamenial epoch, this is a matter of simple coincidence, for this bloody flow may occur indifferently at any time of the month.
Suppression of the catamenia is not, howeter, an absolute sign, since we find in all authors accounts of women who have continued to men struate during the first months and even during the entire period of pregnancy. Dnrosiez has drawn attention to the persistence of the menses during pregnancy, and the tendency to abortion in women affected with mitral stenosis, at least during the first three or four months. More than this: cases have been recorded where women only menstruated during pregnancy, but these cases are entirely exceptional, and, as a rule, suppression of the menses is constant in pregnant women. Other signs, such as bloating, and modifications of the umbilical cicatrix, have not the least value.
It is the same with the voluptuous sensation and other phenomena ex perienced by certain women. I have a young patient who is at her fourth pregnancy, and all four times the coitus, that seemed to her to be the im pregnating one, was followed by syncope, which had never occurred in other sexual connections.
[A few years ago, Jorissenne called attention to the fact that, in early pregnancy, the pulse rate remained unchanged in changes of position of the woman, and he based on this fact the early diagnosis of pregnancy. Other observers, however, have not found the sign constant. Frey, of Washington, claims that a difference of .7° between the vaginal and axillary temperatures points to pregnancy.—Ed.] It is different, however, with the changes in the nipple, the appearance of the areola, the tubercles of Montgomery, the presence of milk, which, though liable to deceive in women who have alreaiy had children, are of considerable importance in women who have never been pregnant. Some authors, and Cazeaux amongst them, regard them as of such im portance as to be an almost certain sign. " In a young woman," says Cazeaux, "who has never had children, whose breast shows a brownish and reddened areola, and the tubercles which we have described, I would diagnose pregnancy almost with certainty." [A statement a trifle too strong, for in cases of ovaritis these mammary signs may be most clearly marked.—Ed.] Let us note finally the various pigmentation, the brown abdominal line, the violet markings (old markings are white, like old scars) the color of the vulva, etc.-- The certain signs of pregnancy are: 1st. Active foetal movements—perceived by the accoucheur.
2d. Communicated movements, abdominal and vaginal ballottement.
3d. Beating of the foetal heart.
Each one of these signs alone will suffice for the diagnosis of pregnancy; but they must be recognized by the obstetrician at more than one ex amination.
For instance, every woman who believes herself pregnant without being so, feels life; therefore, another's hand must perceive the motion. Let us see what means we possess to detect these signs. They are: 1st. External examination.
2d. Palpation.
3d. Vaginal and rectal touch.
4th. The bi-manual palpation.
External Examination.
The inspection of a woman whom we suspect to be pregnant should begin at the face, when we often detect that peculiar brownish pigmentation called " la masque," or chloasma; then the breasts should be examined for pigmented areola, or the tubercles of Montgomery, and for the peculiar markings. The abdomen may be increased in size, and show a pigmen tation that extends from the pubes to the xyphoid appendix; this is the brown line. On the sides of the abdominal walls, and down the thighs, peculiar markings may exist, recent ones being of a livid blue, rosy or red, while old ones in multiparte are white, and look like old cicatrices. The labia majors are more or less puffed up and swollen, the orifice of the vagina is more or less deeply colored, and sometimes shows varices like the labia majors and the inferior limbs; the vaginal mucus membrane is livid, and is bathed with a white or yellowish-white secretion, which is more or less abundant in different women.
The abdomen is more or less prominent according to the stage of pregnancy, so much so as to sometimes fall forward like a sack, but always forming a considerable protuberance, varying with the amount of resistance of the abdominal wall. The umbilical cicatrix may be prominent or depressed, or drawn upwards or downwards; it is always more or less en larged. Finally, two peculiar phenomena may be noticed. The one is seen in women who have thin abdominal walls, and consists of momen tary elevations and depressions of portions of the abdominal surface from active foetal motions. The other is a special projection of the abdomen seen in some women when they lie curled up in bed. It is only seen in multiparce, and is due to the projection forward of the uterus between the separated borders of the recti muscles from yielding of the lines alba (eventration.) At the close of pregnancy the uterus fills the entire abdominal cavity, and the thorax is drawn up high to enlarge the abdominal capacity.
Any of these signs, it is true, might be found in states, other than that of pregnancy; taken singly, they do not count for much, but to gether they have a very great importance.
Percussion has only a very relative value in the diagnosis of pregnancy. It gives us but very incomplete information, and is only of value when associated with other methods of exploration. But it is very different with auscultation, for the hearing of the foetal heart sounds is a certain sign of pregnancy.