Probable Signs of Early Pregnancy

Posted on August 23, 2007
Filed Under Early Pregnancy Symptoms |

This is the examination of the external and internal genitalia. You should empty your bladder before it is carried out, as a full bladder can be mistaken for a pregnant uterus. A full bladder will also make the examination more uncomfortable and confuse the accurate measurement of the uterus.You will be asked to lie on your back, with your buttocks on the edge of the examining table, your heels in footrests, and your knees relaxed and wide apart. Many women feel very exposed and vulnerable in this position and have trouble relaxing. Most women are more comfortable with their head and back propped up. In this upright position, you can be actively involved in the examination. With the help of a small hand ­held mirror you can observe everything the physician or midwife is doing. You hold the mirror with one hand against your inner thigh, angled toward your vagina and a bit off to the side so as not to get in the way of the light that the examiner uses. A magnifying mirror might make it easier to see. You will be able to see the urethra, the anus, and the opening of the vagina as well as the vaginal walls and cervix after the speculum is placed. You may be able to see the bluish tone to the cervix that is associated with pregnancy. To allow for better visualization, and also because drapes tend to be a barrier preventing eye contact between patient and examiner, some providers prefer to use minimal or no drapes during a pelvic examination.

If you like the idea of this style of pelvic examination, and those providing your care do not customarily employ it, there is no reason you cannot request it. You can consider taking your own mirror with you to the examination and ask that the head of the examining table be raised. Ask the physician or midwife to show you what he or she is observing and palpating.

The principal changes in the vagina during pregnancy are three fold -

• Increased blood supply. Pelvic circulatory changes appear early in pregnancy, usually before the second missed period. These changes cause the tissues around the entrance of the vagina and within it to take on a purplish, dusky color instead of the nonpregnant pink. The color change is called Chad wick’s sign. The color deepens as pregnancy advances, and is likely to be more striking in those who have already borne children.

• Softening of the tissues. As pregnancy advances, the vagina becomes increasingly elastic and distensible because of the softening of the tissues that form its walls.

• Extra secretions. The increase in vaginal secretions that usually occurs with pregnancy is largely due to an increase in activity of the mucus-secreting glands of the cervix .

A pelvic examination begins with inspection-looking at the tissues for their normalcy. The entire vaginal area is inspected, including the vulva, the vaginal lips, the clitoral area, the area between the vaginal entrance and the anus and the anal area. The examiner uses one hand to separate the labia to observe the urethral opening and to see if there are unusualProbable Signs of Early Pregnancy secretions from the glands surrounding the urethra. The examiner will palpate or gently squeeze the lower part of both sides of the vagina to see if there is any tenderness or swelling in the area of the Bartholin’s glands. You may be asked to cough or bear down to check whether you have a weakness in either the upper (anterior) or lower (posterior) vaginal wall. Some examiners may then insert two fingers slightly into the vaginal opening and ask you to squeeze your vaginal muscles around their fingers. This tests the strength of your vaginal muscles, important for pushing in labor and for preventing problems later in life such as loss of urine with coughing or laughing and prolapse of the uterus, a condition in which the uterus descends into the vagina. If these muscles are weak, your care provider will suggest Kegel exercises to improve muscle tone.

Following observation of the external genitalia, the examiner inspects the inner vagina and cervix. This is done by opening the vaginal walls with an instrument called a speculum. The examiner may press against the vaginal walls to help insert the speculum, which hopefully is warmed and slightly lubricated with warm water. The speculum may be made of sterilized steel or disposable plastic. The plastic speculum may feel warmer, but often makes a clicking sound when removed which might be somewhat startling.

Once the cervix is visualized, the examiner can take material for a Pap smear. Using either a small cotton-tipped applicator (similar to a Q-tip with a longer handle) or a small plastic brush, the examiner will gather cells from the opening of the cervix. These are rotated in the cervical opening or os (Latin os’= mouth). A small wooden spatula, looking like a narrow tongue blade, is often used to gather cells from the outside of the cervix. Newer brushes take cells from both the inner and outer cervix simultaneously, so the spatula may not be needed. These cells are placed on a slide or in a small jar to be sent to a laboratory for analysis. You may have some slight spotting right after this examination, especially if the brush is used. This is perfectly normal and should not be a cause for concern, unless the bleeding continues or is very heavy.

Cervical sampling usually is painless, although some women report sensitivity when the applicator touches the cervix. The whole thing takes less than a minute. After the Pap smear, cultures are taken for sexually transmitted diseases-gonorrhea and chlamydia. The technique is similar: an applicator is inserted gently into the cervix, rotated, removed, and placed into a special solution to be sent to the laboratory. This takes about another 30 seconds.

In the laboratory the Pap smear specimen is studied under the microscope by a cytologist (Greek kytos = cell). The cytologist can detect cancerous cells, pre cancerous cells, and cells that may not be pre cancerous but are unusual. The specimen can also show some types of infections. The laboratory’s report may not be ready until several days or even a few weeks after the smear is obtained.

After the Pap smear and cultures are taken, the speculum is removed and the bimanual examination is performed. Two fingers are inserted into the vagina to feel the internal organs and the other hand placed on the abdomen just above the pubic bone. The cervix can be felt as a slightly firm structure protruding into the upper vagina and attached to the uterus, which is more or less enlarged and softened depending on the duration of the pregnancy. The examining fingers feel the uterus, getting an idea of its size, shape, and consistency. The tissues to either side of the uterus are palpated to identify the ovaries, if possible, and any abnormal structures, such as ovarian cysts or fibroids that are coming off the side of the uterus.

One very important part of the pelvic assessment in pregnancy, especially if the first visit is in the first trimester (3 months), is to compare size of the uterus to the expected size based on the woman’s last menstrual period. In very early pregnancy, the body of the uterus remains firm while the midportion between the body and the cervix softens. This is called Hegar’s sign and is suggestive of pregnancy. Still later on, the body of the uterus softens and becomes increasingly spherical and, in the presence of a single fetus, enlarges in an entirely predictable manner. By the eighth week of pregnancy the bulk of the uterus is approximately doubled and by the twelfth week it is tripled.

If the uterus is smaller than expected, the pregnancy may be growing abnormally or the dates may be off. An unexpectedly large uterus may indicate fibroids or a multiple pregnancy, or just that the dates are off in the opposite direction. 1n either of these cases, correct diagnosis is established by watchful waiting or by sonography, depending on when 1n the pregnancy the examination is done and how many weeks off the exam is from projected dates. A discrepancy of 2 weeks between the expected date by last menstrual period and the size of the uterus is perfectly within the realm of normal.

At the time of the first pregnancy pelvic examination, the examiner often makes an estimation of the adequacy of the bones of the pelvis for the passage of a normal-sized infant. Nowadays contraction of the bony pelvis sufficient to obstruct birth is an exceedingly rare event, unless the fetus is extraordinarily large. Congenital abnormalities of the pelvis are rare, and the marked deformities due to rickets and malnutrition seen four or five generations ago rarely exist today. Many practitioners, however, like to know whether the pelvis is on the smaller or larger side of normal. They can also assess its specific shape.


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