Diagnosis of pregnancy.

The number of unplanned pregnancies is increasing among college students in U.S. campuses. Physicians must be alert to the diagnosis of pregnancy in every female patient and to exclude pregnancy before prescribing X-rays or certain drugs. The signs and symptoms of diagnosis can be classified into 3 groups the postive signs the probable signs and the presumptive evidence of pregnancy. The positive signs are identification of the fetal heartbeat reception of active fetal movement and recognition of the fetus radiologically or sonographically. These signs cannot be detected until the 16th or the 20th week of pregnancy; real-time scanning can detect fetal cardiac movement by the 7th week of gestation. The probable signs of pregnancy include enlargement of the uterus changes in size shape and consistency of the uterus changes in the cervix and positive pregnancy test detecting human chorionic gonadotropin in maternal plasma and its excretion in urine. Presumptive evidence of pregnancy includes signs and symptoms that a woman can detect by herself such as cessation of menses changes in the breasts changes in the color of the vaginal mucosa skin pigmentation appearance of abdominal striae nausea with or without vomiting disturbances in urination fatigue and sensation of fetal movement. The article reports on 4 unusual presentations of pregnancy; in all cases although intrauterine pregnancy was not the primary diagnosis there was presumptive evidence. Failure to investigate for possible pregnancy may lead to incorrect diagnosis inappropriate therapy and at times to medical-legal embroilment.