Confirming Pregnancy

Know the pregnancy symptoms

• Delayed period (amenorrhoea): If your menses are delayed more than 10 days beyond the due date, with previous periods being regular and you have been sexually active, there is a very good chance of you having become pregnant.
• "Morning sickness"(nausea): feeling sick, or vomiting in the morning (give a link for reasons).
• Breast changes: Fullness, prickling sensations and heaviness in breasts is common. Your breasts may feel painful to touch also.
• Urine problems: Feeling like urinating more often.
• Tiredness (fatigue): feeling unusually tired and lethargic.
• Food fads: Traditionally the image of a woman eating pickle /"imli" or other sour foods has been used to suggest pregnancy in Indian movies. There is some basis to this, as most women develop strong likes and dislikes for various food items in pregnancy. Rarely, there could also be craving for unusual thing such as mud.
• Increased vaginal discharge.
  
  

Other bodily changes include:

• Constipation.
• Mood changes.
• Irritability.
• Excessive salivation.

Home Pregnancy Tests Help

Advances in laboratory testing have now reached a stage where we have access to easy-to-use reliable pregnancy test kits over the counter.

In pregnancy, the growing tissues of the new conception (early foetus) secrete a special hormone into your body called ‘human Chorionic Gonadotrophin’ hCG). This enters your blood as early as one week following fertilisation. This can be traced from your blood or urine by special tests. Home tests are done with urine.

Depending upon the type and sensitivity of the test used, pregnancy can be detected as early as a day or two from the missed period.

Tests currently available include

1) In the first week (within 7 days of missed periods)

• Pregcolor card (used extensively in India)
• Velocit one step pregnancy test

Both these tests use the principle of two colored bands appearing if you are pregnant and only one band appearing if you are not

2) Within 2 weeks of missed period:

• Pregcolour bottle
• Granindex slide test

These tests need a higher level of hCG before they become positive. Hence they become positive after five weeks from the last menstrual period.

Points to be noted:

For best results, you must take care that

• Urine is collected in a clean, dry container.
• Early morning sample of urine is preferred.
• A fresh sample is preferable

It may happen that a test result comes negative although you may be, in reality pregnant. This is more likely if:

• Your cycles are irregular or are often delayed.
• The testing has been done very early in pregnancy.In such cases, if the test is repeated after one week, it may become positive.

It is always advisable to confirm the pregnancy diagnosis by a qualified medical practitioner as all tests have their limitations.

Your first visit to the doctor

As discussed earlier, you may feel certain changes in your body, which tell you that you are pregnant. You may have done a home test to find out. However, it is good to consult a doctor to be sure. This is how your doctor can help you.

Signs (What the Gynaecologist sees / feels) There various subtle changes in your body in pregnancy, which can be assessed before there are obvious physical changes.

General Examination

• Pulse rate goes up by 10 – 15 beats / minute
• Skin pigmentation increases. You may have a darker colored "butterfly" distribution rash on the face (chloasma).Using a sun protection cream may reduce the pigmentation
• Blood pressure tends to go low

Breasts

• Darker pigmentation of the areola (area around nipple) and of the nipples
• Congestion of breasts and dilated veins seen over the breast

Genital Tract

• Increased vaginal discharge (leucorrhoea) is common
• Dark, bluish discoloration of vagina and cervix due to congestion
• The cervix and uterus feel soft
• The uterus gradually starts increasing in size as pregnancy advances. However, it is difficult even for an experienced Gynaecologist, to definitely confirm pregnancy only by uterine size before 6 weeks from the last period. It is only after 3 months that the uterus can be felt on abdominal examination. Before that, an internal check-up is necessary

Confirmatory Tests

After examining you, your doctor may feel that certain tests need to be done. In particular, for early pregnancy you may be advised to do the following tests:

• Serum beta - hCG: to confirm the pregnancy if urine testing is not conclusive, or help to decide the further treatment in case of complications, Such as presence of bleeding / spotting in early pregnancy
• Sonography: This test is very useful for various Gynaecological conditions, especially pregnancy

Role of Sonography in Confirming Pregnancy :

Abdominal sonography, scanning is done through a full bladder to see the uterus. Depending on the machine and operator’s experience, you can usually find

• A small echodense ring ( gestational /pregnancy sac in which the foetus is suspended or enclosed ) by 6 weeks
• See foetal echoes within the gestational sac by 8 weeks latest. Transvaginal (internal) sonography, The resolution is better and pregnancy can be picked up earlier, as early as 4 and half weeks

Is it necessary in all cases ?

Abdominal sonography, scanning is done through a full bladder to see the uterus. Depending on the machine and operator’s experience, you can usually find

• A small echodense ring ( gestational /pregnancy sac in which the foetus is suspended or enclosed ) by 6 weeks.
• See foetal echoes within the gestational sac by 8 weeks latest. Transvaginal (internal) sonography, The resolution is better and pregnancy can be picked up earlier, as early as 4 and half weeks.

Is it necessary in all cases ?

Not necessary if:

• Your periods are fairly regular; you are not having any problem
• You remember your LMP (Last Menstrual Period) date properly

May be necessary if:

• Your periods are irregular
• You are not sure of your dates
• Your doctor feels it is advisable

Necessary if:

• You have any bleeding after missing a period
• There is doubt about whether the pregnancy is growing well
• There is suspicion of abnormal pregnancy especially ectopic or extra uterine pregnancy

Calculation of Due Date

Once you are sure you are pregnant, the question that comes to your mind, often, is when are you likely to deliver.There are various ways to estimate the due date, but you must remember that it is never absolutely a certain date. Although majority of women will deliver within a week before or after the due date, there may be variations Link to pre-term labour and prolonged labour in Abnormal deliveries

• Naegles rule: For a woman with regular 28 day cycles, the expected due date (EDD) can be calculated by adding 9 calendar months and 7 days to the first day of the last menstural period (LMP)
  For Eg:
  LMP 10-06-1999 -------- EDD 17-03-2000
  LMP 28-10-1999 ---------EDD 04-08-2000.
  
• If your cycles are regular, but either more or less than 28 days, you can calculate the date by adjusting the difference from 28.
  For E.g.:
  LMP 10-06-1999, cycles 30 days = EDD 19-03-2000
  LMP 28-10-1999, cycles 25 days = EDD 01-07-2000
  
• Your doctor will usually use this formula and calculate your date, so do not worry if your calculative skills are not good.