A flattening of the upper wall of the vagina, produced by the enlargement and anteversion of the uterus, which, forcing the os towards the sacrum, makes the anterior wall of the vagina tense, has been added by Dr. Barnes as a sign of pregnancy.
Certain Signs
1. Ballottement.—This test of pregnancy is applied by causing the patient to stand upright; the finger of the right hand is then passed into the vagina and placed in the anterior fornix, the other hand being placed lightly over the abdomen in order to steady the uterine tumour. If the finger be now jerked upwards against the head of the child, it will be felt to float upwards in the liquor amnii, and then by its own weight gradually to return to its former position. Tumours in the uterus, attached to its walls by a pedicle, may give the same sensation. Scanty supply of liquor amnii, or malposition of the child, may sometimes prevent the adoption of the test.
2. Uterine Souffle.—Under this head are included the placental bruit, and the pulsations of the umbilical cord. Both these sounds require a skilled auscultator to detect them. The uterine murmur, or bruit placentaire, is heard best at the lower and lateral portions of the uterus, just above Poupart‘s ligament. It is isochronous with the pulse of the mother, and is heard most distinctly about the fourth or fifth month of utero-gestation; in some cases, however, it may be heard as early as the tenth week. The sound is intermittent, and varies in character, being sometimes hissing, whirring, or cooing, at others rasping.
3. Pulsation of the Fœtal Heart.—The sounds of the fœtal heart were first noticed by Mayar in 1818, and those of the placenta, or placental souffle, by Kergaradec in 1822. The sound of the fœtal heart is composed of a rapid succession of short, regular double pulsations, differing from that of the adult heart in rhythm and frequency. It can be heard more or less over the whole of the abdomen about the middle of the fourth month, and is not unlike the muffled ticking of a watch. In frequency it varies from 100 to 140. The auscultator should be careful not to hang his head down, or he may be apt to mistake the throbbing of his own arteries for sounds communicated from the patient.
4. Intermittent Contraction of the Uterus.—From the fourth to the tenth month of pregnancy, the uterus may be felt by the palpating hand to alternately contract and relax; the period of contraction and relaxation varies. It is present in pregnancy whether the fœtus be alive or dead.
Pregnancy may be simulated by ascites, by fibrous tumours of the uterus, by ovarian dropsy, and by enlargement of the uterus from retention of the catamenia due to an imperforate hymen, &c. The breasts may also become affected by uterine tumours.
Diagnosis of Pregnancy
1. Pseudo-Pregnancy.—In the examination of cases of alleged pregnancy, the medical jurist should bear in mind the possibility of enlargement of the uterus and abdomen from the presence of tumours. The probable occurrence of pseudo-pregnancy should also be considered. Tumours and pseudo-pregnancy may occur in the married and unmarried; and as the latter is not infrequently accompanied with many of the signs and symptoms of pregnancy, an early diagnosis is of the utmost importance.
The diagnosis will consist in—