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Give me answers accordingly to Dutta textbook of obgy
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D C Dutta textbook pregnancy diagnosis probable signs Goodell Hegar Chadwick
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Case diagnosis
This woman has probable pregnancy of about 10 weeks' gestation.
The history of amenorrhoea with nausea/vomiting and the pelvic findings of a 10-week-size uterus, soft cervix, and soft lower uterine segment support the diagnosis.
1. Probable signs of pregnancy in this case
| Finding | Significance |
|---|---|
| Uterus enlarged to approximately 10 weeks' size | Uterine enlargement |
| Cervix is soft | Goodell's sign |
| Lower uterine segment/isthmus is soft on bimanual examination | Hegar's sign |
| Amenorrhoea, nausea and vomiting | Presumptive, or subjective, symptoms, not probable signs |
Other probable signs include Chadwick's sign, uterine souffle, Braxton Hicks contractions, ballottement, and positive pregnancy test.
2. Goodell's, Hegar's and Chadwick's signs
Goodell's sign
- Softening of the cervix, especially the vaginal portion.
- It occurs due to increased vascularity, oedema, and hypertrophy of the cervical tissues.
- Usually appreciable by about 6 weeks of pregnancy.
Hegar's sign
- Marked softening and compressibility of the lower uterine segment or uterine isthmus.
- On bimanual examination, the abdominal and vaginal fingers appear to approximate because the softened isthmus offers little resistance.
- Usually appreciable around 6-12 weeks of gestation.
- This is the sign described in the case.
Chadwick's sign
- Bluish or violaceous discoloration of the vagina, vulva, and cervix due to pelvic congestion and increased vascularity.
- Usually seen from about 6-8 weeks of pregnancy.
These are classical probable signs, so they strongly suggest but do not prove a pregnancy. A similar classification is described in OpenRN's pregnancy-diagnosis reference.
3. Other conditions that can cause uterine enlargement
Differential diagnoses include:
- Fibroid uterus - usually irregular, firm, and may be associated with menorrhagia.
- Adenomyosis - uniformly enlarged, boggy, and often tender uterus with dysmenorrhoea/menorrhagia.
- Hydatidiform mole - uterus may be larger than the period of amenorrhoea, with excessive vomiting and high beta-hCG.
- Endometrial carcinoma or pyometra - less likely in a young woman, but may enlarge the uterus.
- Hematometra - accumulation of blood in the uterine cavity due to outflow obstruction.
- Ovarian tumour or pelvic mass - can sometimes be mistaken for uterine enlargement on abdominal examination.
- Full urinary bladder - may simulate a pelvic/uterine mass.
4. Confirmation of pregnancy
Pregnancy should be confirmed by:
- Urine pregnancy test - detection of hCG.
- Serum quantitative beta-hCG - useful when an early pregnancy or ectopic pregnancy is suspected.
- Transvaginal ultrasonography - confirms an intrauterine gestational sac, yolk sac, fetal pole, and fetal cardiac activity. At 10 weeks, a live embryo/fetus with cardiac activity should normally be demonstrable.
- A definite clinical confirmation is demonstration of fetal cardiac activity by Doppler, usually from about 10-12 weeks, or visualization of the embryo/fetus by ultrasonography.
Positive signs of pregnancy are fetal heart sounds heard by the examiner, fetal movements palpated by the examiner, and ultrasonographic visualization of the fetus.
Note: I could not access a Dutta textbook copy in the available reference library, so the wording is based on the standard classical obstetric teaching used in Dutta-style undergraduate answers.
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