Pregnancy Diagnosis

Diagnosis of pregnancy can be done by symptoms, laboratory evaluation and ultrasonography.

Symptoms/History:

1. Recent unprotected sexual activity.
2. Recent Amenorrhea (Absence of menstruation) in a woman having regular menses in past. Up to 25% of the women may bleed during their first trimester.
3. Feeling of nausea, vomiting.
4. Painful breast and nipple.
5. Fatigue.
6. Urinary frequency.
7. Food cravings.
8. Implantation bleeding: There may be a slight staining of a pink or brown color and cramping about 8 days after ovulation. There may also be some spotting around the time you expect your period.

Early signs of pregnancy may include:

1. Darkening of nipples and areola.
2. Blue discoloration of the cervix and vagina (Chadwick's sign) observed at approximately 6 week.
3. Softening and enlargement of the cervix (Hegar's sign) observed at approximately 6 week.
4. A gravid uterus may be palpable low in the abdomen usually by 12 weeks.

Laboratory Evaluation:

Several tests can be helpful in the diagnosis of pregnancy.

1. Urine Test:

The most commonly performed test is for presence of a glycoprotein, Beta-human chorionic gonadotropin in urine. Free beta subunits are degraded in the kidney, which is detected in urine samples. Currently, 4 main hCG assays are used:
a) Radioimmunoassay has sensitivity to approximately 5 mIU/mL of hCG and become positive by 10-18 days of conception.
b) Immunoradiometric assay has Sensitivity to approximately 150 mIU/mL of hCG and become positive by 18-22 days of conception.
c) Enzyme-linked immunosorbent assay has Sensitivity to approximately 25 mIU/mL of hCG and become positive by 14-17 days of conception.
d) Fluoroimmunoassay has Sensitivity to approximately 1 mIU/mL of hCG and become positive by 14-17 days of conception.

2. Blood Test:

a) Serial hCG monitoring: hCG is detectable in the serum of more than 98% of patients by day 11.
b) Progesterone: Measuring serum progesterone may be a useful for early pregnancy. Currently, radioimmunoassays and fluoroimmunoassays are available. A dipstick ELISA is available that can determine a serum progesterone level of less than 15 ng/mL.

3. Ultrasonography:

Trans-vaginal ultrasonography (TVUS) can made the diagnosis of pregnancy more accurate and earlier than with conventional trans-abdominal ultrasonography (TAUS). The following are the advantage of TVUS over TAUS:
a) Can detect intrauterine pregnancy approximately 1 week earlier,
b) No a full bladder is required,
c) No uncomfortable pressure is exerted on the abdominal wall from the external probe,
d) Better for obese patients.
• Few rapid (urine) test kits to diagnosis the pregnancy are Pregcolor Card, H.Y.T, RapiCard™.

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