Operational Medicine Medical Education and Training

Normal Pregnancy

Diagnosis of Pregnancy

Pregnancy may be suspected in any sexually active woman, of childbearing age, whose menstrual period is delayed, particularly if combined with symptoms of early pregnancy, such as:

  • Nausea (1st trimester)

  • Breast and nipple tenderness (1st trimester)

  • Marked fatigue (1st and 3rd trimesters)

  • Urinary frequency (1st and 3rd trimesters)

  • The patient thinks she's pregnant

Early signs of pregnancy may include:

  • Blue discoloration of the cervix and vagina (Chadwick's sign)

  • Softening of the cervix (Goodell's sign)

  • Softening of the uterus (Ladin's sign and Hegar's sign)

  • Darkening of the nipples

  • Unexplained pelvic or abdominal mass

First trimester fetal ultrasound scan

Normal Pregnancy

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Measuring the Fundal Height during Pregnancy

Pregnancy Tests

The diagnosis of pregnancy is accurately made with a urine pregnancy test. Current test kits are highly specific and detect 35-30 mIU of HCG (human chorionic gonadotropin, the pregnancy hormone) per ml of urine. In other words, the pregnancy test will be turning from negative to positive at about the time of the first missed menstrual period.

In the event of an "equivocal" pregnancy test...one that is not really positive nor negative, additional urine can be put through the test kit to boost the sensitivity. Instead of using 3 drops of urine, you can use up to 6 drops of urine. This will virtually double the sensitivity of the test, while increasing the chance of a false positive by only a small amount.

In an urgent situation, if a patient is unable to provide urine for the test, serum can be used in the urine test kit in place of urine.

  • Draw blood into a test tube.

  • Tape the test tube to the wall for about 10 minutes (allow it to clot).

  • Using an eye dropper or a syringe with a needle, draw off a small amount of serum (the clear, watery part of the blood that's left at the top of the test tube after the blood has clotted).

  • Use the serum instead of urine in the urine pregnancy test kit, drop for drop. If the test kit calls for 4 drops of urine, use 4 drops of serum.

This is an imperfect solution, because the forms of HCG (pregnancy hormone) found in serum are somewhat different from the forms found in urine. Further, the serum proteins tend to sludge up the test kit, both mechanically and biochemically. That said, using serum instead of urine will work well enough for most purposes in an operational setting and can provide immediate insight into the patient's problem.

Prenatal Care

At the first prenatal visit, take a careful history, looking for factors that might increase the risk for the pregnant woman. Many providers use a questionnaire, filled out by the patient, as a starting point for this evaluation. A sample Prenatal Registration and Obstetrical Questionnaire form can be used for this purpose.

One important aspect of prenatal care is education of the pregnant woman about her pregnancy, danger signs, things she should do and things she should not do. Many providers find it useful to give the woman printed material covering these issues that she can take with her. This allows her to read the material at a later time and to refer to it whenever she has questions. A sample Prenatal Information form can be printed and used.

Routine visits:

  • every 4 weeks until 28 weeks' gestation

  • every 2-3 weeks until 36 weeks' gestation

  • every week from 36 weeks to delivery

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