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Snegirev's sign is a sign of pregnancy. Gynecological diseases. Reliable signs of pregnancy


The diagnosis of pregnancy is undoubted if, during examination, parts of the fetus, heartbeat and fetal movements are determined, and during ultrasound examination - the fertilized egg. These reliable signs of pregnancy do not appear at the beginning of it, but at a later date (V-VI months). In the early stages, the diagnosis of pregnancy is made on the basis of presumptive and probable signs.

Presumable (doubtful) signs of pregnancy

Presumable signs include manifestations of general changes associated with pregnancy:

Changes in appetite (aversion to meat, fish, etc.), cravings (craving for spicy foods, unusual substances - chalk, clay, etc.), nausea, vomiting in the morning;

Changes in olfactory sensations (aversion to perfume, tobacco smoke, etc.);

Changes in the nervous system: irritability, drowsiness, mood instability, etc.;

Skin pigmentation on the face, along the white line of the abdomen, nipples and areola.

Possible signs of pregnancy

This group of signs includes changes in menstrual function and changes in the genitals:

- cessation of menstruation;

The appearance of colostrum from the milk ducts opening on the nipple when pressing on the mammary glands;

Blueness (cyanosis) of the mucous membrane of the vagina and cervix;

Changes in the size, shape and consistency of the uterus;

Laboratory tests (determination of chorionic hormone in urine and blood).

Reliable signs

- Identification of fetal parts by palpation of a woman’s abdomen (Leopold’s maneuvers).

Determination of fetal movements during palpation: sensation of fetal movement during palpation or ultrasound.

- Listening to fetal heart sounds. The diagnosis of pregnancy is confirmed by listening to fetal heart sounds, the frequency of which is 120/140 per minute. Heart contractions can be determined from 5-7 weeks using instrumental research methods: ECG, phonocardiography, cardiotocography, ultrasound, and from 17-19 weeks - auscultation.

Possible signs of pregnancy are identified by:

Feeling the mammary glands and squeezing out colostrum;

Examination of the external genitalia and vaginal opening;

Research using mirrors;

Vaginal and two-manual vaginal-abdominal examination of a woman.

Delayed menstruation is an important sign, especially in women with regular cycles. The significance of this symptom increases if it is combined with engorgement of the mammary glands and the appearance of colostrum in them, with the occurrence of cyanosis of the vagina and especially the vaginal part of the cervix, with a change in the size and consistency of the uterus.

As pregnancy progresses, the size of the uterus changes. Changes in the shape of the uterus are determined by two-handed (bimanual) examination. The uterus in non-pregnant women is pear-shaped, somewhat compacted in the anteroposterior dimension. With the onset of pregnancy, the shape of the uterus changes. From 5-6 weeks, the uterus takes on a spherical shape. Starting from 7-8 weeks, the uterus becomes asymmetrical, one of its corners may protrude. By about 10 weeks, the uterus becomes spherical again, and by the end of pregnancy it takes on an ovoid shape.

The following signs indicate the presence of pregnancy:

Enlarged uterus . Enlargement of the uterus is noticeable at 5-6 weeks of pregnancy; The uterus initially increases in the anteroposterior direction (becomes spherical), and later its transverse size also increases. The longer the pregnancy, the clearer the increase in uterine volume. By the end of the second month of pregnancy, the uterus increases to the size of a goose egg; at the end of the third month of pregnancy, the fundus of the uterus is at the level of the symphysis or slightly above it.

Horwitz-Hegar sign . The consistency of the pregnant uterus is soft, and the softening is especially pronounced in the isthmus area. During a two-handed examination, the fingers of both hands meet in the isthmus area with almost no resistance. This symptom is very typical for early pregnancy.

Snegirev's sign .Pregnancy is characterized by slight changes in the consistency of the uterus. During a two-handed examination, the softened pregnant uterus becomes denser and shrinks in size under the influence of mechanical irritation. After the irritation stops, the uterus again acquires a soft consistency.

Piskacek's sign. In the early stages of pregnancy, asymmetry of the uterus often occurs, depending on the dome-shaped protrusion of its right or left corner from 7-8 weeks.

The protrusion corresponds to the site of implantation of the fertilized egg. As the fertilized egg grows, the protrusion gradually disappears (by 10 weeks).

Gubarev and Gaus noticed slight mobility of the cervix in the early stages of pregnancy. Slight displacement of the cervix is ​​associated with significant softening of the isthmus.

Genter's sign. In the early stages of pregnancy, there is an increased anterior bending of the uterus, resulting from a strong softening of the isthmus, as well as a comb-like thickening (protrusion) on the anterior surface of the uterus along the midline. This thickening is not always determined.

Thus, the diagnosis of pregnancy is made based on clinical examination data. However, in some cases, when it is difficult to diagnose pregnancy or for the purpose of differential diagnosis, laboratory diagnostic methods are used. Diagnosis of early pregnancy is based on the determination of substances specific to pregnancy in the biological fluids of a woman’s body.

Modern methods for diagnosing pregnancy are divided into biological, immunological, echographic (ultrasound diagnostics) and others.

Both biological and immunological methods are based on the determination of choriogonadotropin (CG), a hormone secreted by the chorion, in biological material (most often in urine). Choriogonadotropin (CG) is close in its chemical nature to pituitary lutropin (LH), is a glycoprotein with a relative molecular weight of 37900. The hormone consists of two peptide chains (a and b -subunits), one of which ( a ) is the same for all glycoproteins - hCG, lutropin (LH), follitropin (FSH) and thyrotropin (TSH), and the other - b -specific to each of them. b -hCG subunit with a relative molecular weight of 23000 has specific hormonal activity. The synthesis of hCG begins from the first days of pregnancy and continues until childbirth with maximum production on the 60-70th day after implantation. Then its level decreases and remains stable until childbirth.

Currently, immunological methods are used to diagnose early pregnancy. Immunological methods are based on a precipitation reaction with rabbit antiserum, or on complement fixation, or on suppression of the hemagglutination reaction. The most widely used method was the suppression of the hemagglutination reaction, developed simultaneously in two laboratories in 1960, Z. S w ierczynska, E. Samochowiec (Poland) and L. Wide, C. Gemzell (Sweden). The method is based on inhibition of the agglutination reaction between red blood cells “charged” with hCG (antigen), antiserum to hCG (containing specific antibodies) and added urine. When red blood cells “charged” with hCG (antigen) and the urine of a pregnant woman are added to the antiserum (antibodies), the hCG present in it binds to the antiserum, and the red blood cells do not undergo agglutination and settle to the bottom of the ampoule. If the urine of a non-pregnant woman, which does not contain hCG, is added, an agglutination reaction occurs and the red blood cells are distributed evenly in the ampoule. To carry out a diagnostic reaction, the contents of the ampoule are dissolved in 0.4 ml of the phosphate buffer supplied with the kit and two drops of fresh morning filtered urine are added using the supplied capillary. The contents of the ampoule are mixed and the ampoule is placed at room temperature. After 2 hours, the reaction is taken into account: the uniform distribution of red blood cells in the ampoule indicates the absence of pregnancy, their settling to the bottom in the form of a ring or button indicates the presence of pregnancy.

Radioimmunological method 10 times more sensitive than immunological. The most common method is double antibodies, based on the precipitation of antibodies to the hormone. For radioimmunological determination of hCG, it is best to use ready-made kits produced by various companies. The use of radioimmunological methods makes it possible to determine a hCG level of 0.12-0.50 IU/l within 5-7 days after implantation of the fertilized egg. The latest radioimmunological methods of determination b -subunits in the hCG molecule make it possible to determine its level of 3.0 IU/l. Determination time is 1.5-2.5 minutes.

Immunoenzyme express methods determination of hCG or b -CG in the urine makes it possible to diagnose pregnancy 1-2 weeks after nidation of the fertilized egg.

There are test systems for quickly determining the presence or absence of pregnancy, which women themselves can use.

Other research methods

The study of basal temperature is based on the effect of progesterone on the thermoregulation center located in the hypothalamus (hyperthermic effect). During the first 3 months of pregnancy, the basal temperature, measured in the morning on an empty stomach in bed with the same thermometer, is above 37 ° C.

The study of the properties of cervical mucus is also based on the effect of progesterone on the physicochemical properties of mucus. During pregnancy, starting from its earliest stages, there is no “pupil” symptom, since the diameter of the cervical canal is less than 0.2 cm. When the secretion from the cervical canal is dried in air, there are no large crystals in it.

Diagnosis of intrauterine pregnancy using ultrasound is possible from 4-5 weeks (from the first day of the last menstruation!). In this case, in the thickness of the endometrium, the fertilized egg is determined in the form of a round formation of reduced echogenicity with an internal diameter of 0.3-0.5 cm. In the first trimester, the rate of weekly growth of the average size of the fertilized egg is approximately 0.7 cm, and by 10 weeks it fills the entire uterine cavity. By 7 weeks of pregnancy, in most pregnant women, when examining the cavity of the ovum, an embryo can be identified as a separate formation 1 cm long. At this time, visualization of the heart is already possible in the embryo - an area with a rhythmic oscillation of small amplitude and weakly expressed motor activity. When performing biometry in the first trimester, the main importance for establishing the gestational age is the determination of the average internal diameter of the ovum and the coccygeal-parietal size (CPR) of the embryo, the values ​​of which are strictly correlated with the gestational age pregnancy. The most informative method of ultrasound examination during early pregnancy is transvaginal scanning; transabdominal scanning is used only when the bladder is full in order to create an “acoustic window”.

DETERMINATION OF PREGNANCY TIME AND DATE OF DELIVERY

The gestational age is determined on the basis of anamnestic data (delayed menstruation, date of the first fetal movement), according to an objective examination (size of the uterus, size of the fetus) and according to additional research methods (ultrasound).

The gestational age and date of birth are determined by:

-By date of last menstruation. The number of days (weeks) at the time of examination of the pregnant woman is counted from the first day of the last menstruation. To determine the date of birth, add 280 days (10 lunar months) to the first day of the last menstruation or use the Naegele formula: from the date of the last menstruation, subtract 3 months and add 7 days. This method cannot be used in women with irregular menstrual cycles.

-By ovulation. If, due to certain circumstances, a woman can name the date of expected conception (rare sexual intercourse, in vitro fertilization (IVF), insemination with donor sperm), then the gestational age is counted from the date of conception, after adding 2 weeks, and the date of birth is determined by counting 38 weeks from the date of expected ovulation, or using the following formula: 3 months 7 days are subtracted from the date of ovulation.

-On first appearance. When registering for pregnancy, a mandatory step in examining the pregnant woman is a vaginal examination, during which the gestational age can be determined with a certain accuracy (see table).

-At the first movement. Determining the duration of pregnancy by the date of the first fetal movement is possible in the second half. On average, primiparous women feel fetal movement starting from 20 weeks, and multiparous women - from 18 weeks of pregnancy.

-According to ultrasound data. The accuracy of determining the gestational age using ultrasound data is quite high, especially in the first trimester of pregnancy. In the second and third trimesters, the error in determining the gestational age by this method increases, which is associated with the constitutional features of fetal development or complications of pregnancy (fetal hypotrophy, diabetic fetopathy, etc.), therefore dynamic ultrasound monitoring of the fetus is of some value.

-On prenatal leave. According to Russian legislation, from 30 weeks of pregnancy a woman has the right to prenatal leave.

To quickly calculate the duration of pregnancy and childbirth, special obstetric calendars are produced.

An objective determination of the gestational age in the first trimester is possible during a bimanual examination of the woman, since the uterus during these periods is located in the pelvis. From 16 weeks, the fundus of the uterus is palpated above the pubis and the gestational age is judged by the height of the fundus of the uterus above the symphysis pubis, measured with a centimeter tape.

The size of the uterus and the height of its fundus at different stages of pregnancy


Gestation period, weeks
Signs

4
The uterus is the size of a chicken egg

8
The uterus is the size of a goose egg

12
The uterus is the size of a man's fist, the bottom is at the upper edge of the womb

16
The fundus of the uterus is in the middle of the distance between the womb and the navel (6 cm above the womb)

20
The uterus extends the abdomen, its bottom is 11-12 cm above the womb, fetal movements appear, a heartbeat is heard

24
Fundus of the uterus at the level of the navel, 22-24 cm above the womb

28
The fundus of the uterus is 4 cm above the navel, 25-28 cm above the womb

32
The fundus of the uterus is in the middle of the distance between the navel and the xiphoid process, 30-32 cm above the pubis, abdominal circumference at the level of the navel is 80-85 cm, the navel is somewhat smoothed, the straight size of the head is 9-10 cm

36
The fundus of the uterus is at the costal arches, at the level of the xiphoid process, abdominal circumference is 90 cm, the navel is smoothed, the straight size of the head is 10-12 cm

40
The fundus of the uterus descends to the middle between the navel and the xiphoid process, 32 cm above the pubis, abdominal circumference 96-98 cm, the navel is protruded, the direct size of the head is 11-12 cm. In primiparous women, the head is pressed to the entrance to the pelvis, in multiparous women it is mobile

To recognize the duration of pregnancy, the correct measurement of the height of the fundus of the uterus above the womb and the volume of the abdomen are of known importance. The height of the uterine fundus above the womb is measured using a centimeter tape or a pelvic gauge, with the woman lying on her back, legs straightened, and the bladder emptied before the examination. Measure the distance between the upper edge of the symphysis and the most prominent point of the uterine fundus. In the second half of pregnancy, the abdominal circumference is measured using a centimeter tape, which is placed in front at the level of the navel, and in the back - in the middle of the lumbar region.

Measuring the length of the intrauterine fetus provides additional data to determine the gestational age. Accurate measurement of the intrauterine fetus is difficult, and the data obtained is only indicative. The measurement is made using a tazomer. The woman lies on her back; The bladder must be emptied before measurement. Having felt parts of the fetus through the abdominal wall, one button of the pelvis is placed on the lower pole of the head, the other - on the bottom of the uterus, where the buttocks of the fetus are often located. V.V. Sutugin found that the distance from the lower pole of the head to the pelvic end is exactly half the length of the intrauterine fetus (from the crown to the heels). Therefore, the value obtained by measuring the distance from the lower pole of the head to the buttocks is multiplied by two. Subtract 3-5 cm from the resulting number depending on the thickness of the abdominal wall. Having determined the length of the fetus, divide this number by 5 and get the gestational age in months.

For convenience of calculations, use the following formula (Skulsky formula):


X = ((L ґ 2) - 5) / 5

Where X- estimated gestational age in lunar months;L– length of the fetus in the uterus when measured with a pelvis;2 – doubling factor;5 in the numerator – the thickness of the abdominal walls and uterine wall;5 in the denominator - the figure by which the number of months is multiplied to obtain the length of the fetus (according to the Haase formula)

For example:

X = ((22.5 ґ 2) - 5) / 5 = 8

Where 8 – the number of obstetric months, or 32 weeks of pregnancy.

To obtain the length of the fetus, use Haase's formula:

in the first half of pregnancy (up to 20 weeks) -

L = X 2 ,

in the second half of pregnancy (after 20 weeks) -L = X ґ 5,

Where X- number of lunar months.

Fetal head measurement provides auxiliary numbers for clarifying late stages of pregnancy. The woman lies on her back; Feel the fetal head as carefully as possible: the pelvic meter buttons are installed at the most prominent points of the head, which usually correspond to the area of ​​the back of the head and forehead. The fronto-occipital size of the head at the end of the 8th month (32 weeks) of the fetus is on average 9.5 cm, at the end of the 9th month (35-36 weeks) - 11 cm.

According to the formula of I.F. Jordania:


X = L + C,

Where X– estimated gestational age in weeks;L– length of the fetus in the uterus, measured by a pelvis;WITH– fronto-occipital size.

For example: if L=22 cm, C=10 cm, then X=32, i.e. The gestational age is 32 weeks.


Using all of the listed methods for determining the gestational age in the first trimester, it is possible to determine the gestational age with an accuracy of 1 week. In the second and third trimesters, the possibility of errors in determining the duration of pregnancy increases. The use of ultrasound scanning (ultrasound) increases the accuracy of determining the gestational age.

CHAPTER 07. DIAGNOSIS OF PREGNANCY

Early diagnosis of pregnancy and determination of its duration are important not only from an obstetric point of view, but also due to the fact that hormonal physiological and anatomical changes caused by pregnancy can significantly influence the course of various extragenital diseases. Accurate knowledge of the gestational age is necessary for adequate examination of patients and management of pregnancy and childbirth.

Diagnosing pregnancy, especially in the early stages, sometimes presents significant difficulties, since some endocrine diseases, stress, and medications can mimic the state of pregnancy. In the future, difficulties arise, as a rule, when determining the duration of pregnancy.

SIGNS OF PREGNANCY

The signs of pregnancy described in classic textbooks on obstetrics have now, with the widespread introduction of ultrasound, lost their significance to a certain extent.

Signs of pregnancy, based on subjective or objective data, are divided into doubtful, probable and reliable.

To the doubtful (supposed) Signs of pregnancy include subjective data:

Nausea, vomiting, especially in the morning, changes in appetite, as well as food cravings;

Intolerance to certain odors (perfume, tobacco smoke, etc.);

Nervous system dysfunction: malaise, irritability, drowsiness, mood instability, dizziness, etc.;

Increased urination;

Breast tension;

Skin pigmentation on the face, along the white line of the abdomen, in the nipple area;

The appearance of pregnancy stripes (scars) on the skin of the abdomen, mammary glands and thighs;

Increased abdominal volume.

Probable signs of pregnancy are determined mainly by objective changes in the genital organs, starting from the first trimester:

Cessation of menstruation (amenorrhea) in a healthy woman of reproductive age;

The appearance of colostrum in nulliparous women when pressing on the nipples;

Cyanosis of the mucous membrane of the vagina and cervix;

Enlargement of the uterus, change in its shape and consistency.

Detection of cyanosis of the vagina and cervix, as well as changes in the size, shape and consistency of the uterus is possible with a special gynecological examination: examination of the external genitalia and the entrance to the vagina, examination of the walls of the vagina and cervix using mirrors, as well as with a two-manual vaginal-abdominal examination.

The following signs are important for diagnosing pregnancy.

Enlarged uterus. The uterus becomes round, enlarged, and soft; by the end of the 8th week, the size of the uterus corresponds to the size of a goose egg; at the end of the 12th week, the fundus of the uterus is at the level of the symphysis or slightly higher.

Horwitz-Hegar's sign. When examined, the uterus is soft, softening is especially pronounced in the isthmus area. During a two-handed examination, the fingers of both hands converge in the isthmus area with almost no resistance (Fig. 7.1). The sign is clearly identified 6-8 weeks after the start of the last menstruation.

Rice. 7.1. Horwitz-Geghar pregnancy sign

Sign of Snow-roar. Variable consistency of the pregnant uterus. During a two-handed examination, the soft pregnant uterus thickens and contracts. After the irritation stops, the uterus again acquires a soft consistency.

Piskacek's sign. Asymmetry of the uterus in early pregnancy is caused by protrusion of its right or left corner, which corresponds to implantation of the fertilized egg. As the fertilized egg grows, this asymmetry gradually smoothes out (Fig. 7.2).

Rice. 7.2. Piskacek's sign of pregnancy

Gubarev and Gauss test. Due to significant softening of the isthmus, there is slight mobility of the cervix in the early stages of pregnancy, which is not transmitted to the body of the uterus.

Genter's sign. Comb-like thickening along the midline of the anterior surface of the uterus. However, this thickening is not always detected (Fig. 7.3).

Rice. 7.3. Sign of pregnancy Gen-tera

Chadwick's sign. In the first 6-8 weeks of pregnancy, the cervix is ​​cyanotic.

Possible signs of pregnancy include a positive result of immunological pregnancy tests. In practice, determination of the level of hCG b-subunit in blood serum is widely used, which makes it possible to establish pregnancy a few days after implantation of the fertilized egg.

Reliable, or undoubted, signs of pregnancy indicate the presence of an embryo/fetus in the uterine cavity.

The most reliable information for diagnosing pregnancy is obtained using ultrasound. With transabdominal scanning, pregnancy can be established from 4-5 weeks, and with transvaginal echography - 1-1.5 weeks earlier. In the early stages, pregnancy is established based on the detection of the fertilized egg, yolk sac, embryo and its heartbeat in the uterine cavity, in later stages - thanks to visualization of the fetus (or fetuses in multiple pregnancies). Cardiac activity of the fetus can be detected by ultrasound from 5-6 weeks of pregnancy, motor activity of the embryo from 7-8 weeks.

DETERMINING THE DATE OF PREGNANCY AND DELIVERY

To determine the duration of pregnancy and childbirth, the date of the last menstruation (menstrual period) and information about the first movement of the fetus are important. Often, the gestational age is determined by the day of expected ovulation (ovulatory period), for which, in addition to the 1st day of the last menstruation, the duration of the menstrual cycle is taken into account and counting is carried out from its middle.

To manage patients at different stages of pregnancy (examination, treatment), three trimesters are conventionally distinguished. The first trimester lasts 12-13 weeks from the first day of the last menstruation, the second - from 13 to 27 weeks, the third - from 27 weeks until the end of pregnancy.

The due date is based on the assumption that a woman has a 28-day menstrual cycle with ovulation on days 14-15. In most cases, pregnancy lasts 10 obstetric (lunar, 28 days) months, or 280 days (40 weeks), if we calculate its beginning from the 1st day of the last menstruation. Thus, to calculate the expected due date, 9 calendar months and 7 days are added to the date of the 1st day of the last menstruation. Usually, the due date is calculated more simply: from the date of the 1st day of the last menstruation, count 3 calendar months ago and add 7 days. When determining the due date, it should be taken into account that ovulation does not always occur in the middle of the cycle. The duration of pregnancy increases by approximately 1 day for each day of the menstrual cycle exceeding 28 days. For example, with a 35-day cycle (when ovulation occurs on the 21st day), the due date will be shifted a week later.

The expected due date can be calculated by ovulation: from the 1st day of expected but not occurring menstruation, count back 14-16 days and add 273-274 days to the resulting date.

When determining the due date, the time of the first movement of the fetus is also taken into account, which is felt by first-time mothers from the 20th week, i.e. from the middle of pregnancy, and for multiparous women - about 2 weeks earlier (from 18 weeks). To the date of the first movement, 5 obstetric months (20 weeks) are added for primigravidas, 5.5 obstetric months (22 weeks) for multigravidas, and the estimated due date is obtained. However, it should be remembered that this sign has only an auxiliary meaning.

For the convenience of calculating the duration of pregnancy by menstruation, ovulation and the first movement of the fetus, there are special obstetric calendars.

To establish the gestational age and date of birth, objective examination data are of great importance: the size of the uterus, the volume of the abdomen and the height of the uterine fundus, the length of the fetus and the size of the head.

The size of the uterus and its height at different stages of pregnancy At the end of the 1st obstetric month of pregnancy (4 weeks), the size of the uterus reaches approximately the size of a chicken egg. At the end of the 2nd obstetric month of pregnancy (8 weeks), the size of the uterus approximately corresponds to the size of a goose egg. At the end of the 3rd obstetric month (12 weeks), the size of the uterus reaches the size of the newborn’s head, its asymmetry disappears, the uterus fills the upper part of the pelvic cavity, its bottom reaches the upper edge of the pubic arch (Fig. 7.4).

Rice. 7.4. Height of the uterine fundus at different stages of pregnancy

From the 4th month of pregnancy, the fundus of the uterus is palpated through the abdominal wall, and the duration of pregnancy is judged by the height of the fundus of the uterus. It should be remembered that the height of the uterine fundus can be affected by the size of the fetus, excess amniotic fluid, multiple pregnancies, abnormal position of the fetus and other features of the course of pregnancy. When determining the duration of pregnancy, the height of the uterine fundus is taken into account in conjunction with other signs (date of last menstruation, first fetal movement, etc.).

At the end of the 4th obstetric month (16 weeks), the fundus of the uterus is located in the middle of the distance between the pubis and the navel (4 transverse fingers above the symphysis), at the end of the 5th month (20 weeks) the fundus of the uterus is 2 transverse fingers below the navel; protrusion of the abdominal wall is noticeable. At the end of the 6th obstetric month (24 weeks) the uterine fundus is at the level of the navel, at the end of the 7th (28 weeks) the uterine fundus is determined 2-3 fingers above the navel, and at the end of the 8th (32 weeks) the uterine fundus stands midway between the navel and the xiphoid process. The navel begins to smooth out, the abdominal circumference at the level of the navel is 80-85 cm. At the end of the 9th obstetric month (38 weeks), the fundus of the uterus rises to the xiphoid process and costal arches - this is the highest level of the fundus of the pregnant uterus, the abdominal circumference is 90 cm, the navel is smoothed .

At the end of the 10th obstetric month (40 weeks), the fundus of the uterus drops to the level at which it was at the end of the 8th month, i.e. to the middle of the distance between the navel and the xiphoid process. The navel protrudes. The abdominal circumference is 95-98 cm, the fetal head descends, in primigravidas it is pressed against the entrance to the small pelvis or stands as a small segment at the entrance to the small pelvis.

Ultrasound determination of gestational age. Echography is of great importance in determining the duration of pregnancy. The main parameter for accurate ultrasound determination of gestational age in the first trimester is the coccygeal-parietal size (CPR) of the embryo. In the II and III trimesters, the gestational age is determined according to various fetometric parameters: biparietal size and head circumference, average diameters of the chest and abdomen, abdominal circumference, femur length. The longer the gestation period, the less accurate the determination of the gestational age of the fetus due to the variability of its size. Ultrasound before 24 weeks of pregnancy is considered optimal for determining the duration of pregnancy.

(A.P. Gubarev, 1855-1931, Soviet anatomist and obstetrician-gynecologist; C.J. Gauss 1875-1957, German gynecologist)

slight mobility of the cervix in all directions, not transmitted to the body of the uterus; early sign of pregnancy.

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Henri Barbusse

From the book of Aphorisms author Ermishin Oleg

Henri Barbusse (1873-1935) writer, public figure To understand life and love it in another being - this is the task of man and this is his talent: and everyone can devote himself completely to only one person. Only saints and the weak need seduction, how in

Barbusse Henri

From the book Great Soviet Encyclopedia (BA) by the author TSB

BARBUS, Henri

From the book Big Dictionary of Quotes and Catchphrases author

BARBUSSE, Henri (Barbusse, Henri, 1873–1935), French writer 8 °Stalin is Lenin today. "Stalin", ch. VIII (1935) ? Dept. ed. – M., 1936, p. 344 81 A man with the head of a scientist, with the face of a worker, in the clothes of a simple soldier. “Stalin”, the final phrase of the book (about Stalin)? Dept. ed. – M., 1936,

BARBUSSE Henri (Barbusse, Henri, 1873-1935), French writer

From the book Dictionary of Modern Quotes author Dushenko Konstantin Vasilievich

BARBUSSE Henri (Barbusse, Henri, 1873-1935), French writer 36 Stalin is Lenin today. “Stalin” (1935), ch.

Henri Barbusse

From the book Foreign Literature of the 20th Century. Book 2 author Novikov Vladimir Ivanovich

Henri Barbusse Fire (Le Feu) Novel (1916) “War has been declared!” World War I. “Our company is in reserve.” “Our age? we are all different ages. Our regiment is a reserve one; it was consistently replenished with reinforcements - some personnel

Henri Barbusse (72)

From the book Letters from Lausanne author Shmakov Alexander Andreevich

Henri Barbusse (72) (1873-1935) Henri Barbusse first arrived in our country in the fall of 1927. Visited the south of Russia and Transcaucasia. On September 20, he made a report in the Hall of Columns of the House of Unions: “White Terror and the Danger of War.” The next year, A. Barbusse repeated the trip. "Upon arrival in

Henri Barbusse on Emile Zola*

author Lunacharsky Anatoly Vasilievich

Henri Barbusse about Emile Zola* It cannot be said that the great founder of French naturalism was bypassed here in the Soviet country. The best proof of this is the fact that it is unlikely that even the French themselves have such a beautifully annotated edition of it.

Henri Barbusse. From personal memories*

From the book Volume 6. Foreign literature and theater author Lunacharsky Anatoly Vasilievich

Henri Barbusse. From personal memories* IIt was in Moscow. This was after our victory. Lenin was already chairman of the Council of People's Commissars. I was with him on some business. Having finished the matter, Lenin told me: “Anatoly Vasilyevich, I re-read Barbusse’s “Fire” again. They say he wrote

Henri Barbusse

From the book Anti-Religious Calendar for 1941 author Mikhnevich D. E.

Henri Barbusse The pre-war works of A. Barbusse (the collection of poems “The Mourners”, the novels “The Asking Ones”, “Hell” and the stories “We are the Others”) are imbued with dissatisfaction, gloomy disappointment and melancholy, a departure from reality into the world of refined psychological

The most characteristic signs of pregnancy can be divided into three groups: doubtful, probable and reliable (undoubted).

Doubtful signs are various kinds of subjective sensations, as well as objectively determined changes in the body, except for changes in the internal genital organs. Such signs may include frequent attacks of nausea, vomiting, loss of appetite, taste whims (addiction to salty or sour foods), changes in olfactory sensations (aversion to various odors), fatigue, irritability, drowsiness. Questionable objective signs include: enlargement of the abdomen, nipples, areola, external genitalia, and the appearance of pregnancy scars (striae) on the skin of the abdomen.

Probable signs are objective signs of changes in the internal genital organs, mammary glands, as well as a positive reaction when performing biological pregnancy tests.

Of the signs indicating a change in the shape and consistency of the uterus in connection with pregnancy, the most important are the following:

1. Snegirev’s sign. During a vaginal examination of the uterus of a pregnant woman, due to mechanical irritation under the fingers of the examiner, it begins to contract and becomes denser.

2. Horwitz-Hegar sign. Vaginal examination reveals softening in the isthmus area. If this softening is expressed sharply, as is often the case, the fingers of the inner and outer hands in the area of ​​the isthmus easily converge. The neck feels like a denser body.

3. Piskachek's sign. During vaginal examination, the contours of the fundus of the uterus and the area of ​​its angles appear irregular. The angle that corresponds to the site of implantation of the fertilized egg bulges significantly more than the opposite angle. The entire uterus appears asymmetrical, with a saddle-shaped bottom.

4. Genter's sign. During a vaginal examination in the early stages of pregnancy, a comb-like protrusion is found on the anterior surface of the uterus, strictly along its midline, which does not extend to the fundus, nor to the posterior surface of the uterus, nor to the cervix. The consistency of the ridge is no different from the rest of the uterine body.

Reliable (undoubted) signs are convincing evidence of pregnancy in the woman being studied. All signs of this group are objective in nature and come only from the fetus.