The diagnosis of early pregnancy : with report of one hundred cases and special reference to the sign of flexibility of the isthmus of the uterus / by Ellice McDonald.

  • McDonald, Ellice, 1876-1955.
Date:
1908
Catalogue details

Licence: In copyright

Credit: The diagnosis of early pregnancy : with report of one hundred cases and special reference to the sign of flexibility of the isthmus of the uterus / by Ellice McDonald. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    could be mistaken for an early pregnancy, caused uterine con- tractions. It may be present in congestive conditions of the mucous membrane; it is sometimes felt on the day before men- struation is established. It was felt by the writer in one case of extrauterine pregnancy in which a large cast of uterine decidual tissue was afterwards passed. However, in spite of these possibilities, the sign remains one of the best corroborative signs of pregnancy. It should not, nor should any single sign be thought sufficient evidence upon which to base a diagnosis of an early pregnancy. SOFTENING AND COMPRESSIBILITY OF THE ISTHMUS—HEGAR’s SIGN. This sign is one of the most popular ones and was first described by Reinl4° from Hegar’s clinic. He described the sign as a softness, compressibility and alteration in the lower uterine segment at that part directly above the insertion of the sacro- uterine ligaments. He advised that the sign could be best elicited by one finger in the rectum. He claimed that the sign could be found in the first month of pregnancy. The phenomenon was afterwards described and investigated by Landau,41 Hegar42 and others, and was found to be a most reliable and accurate sign of early pregnancy. It is now com- monly elicited by placing one or two fingers in the anterior vaginal fornix and the upper or abdominal hand upon the posterior surface of the uterus and attempting to make the finger-tips of each hand meet. A striking absence of resistance is noticed and well-defined compressibility is found. The value of the sign depends upon the recognition of certain conditions. If the uterus is in a state of contraction, it is impossible on account of the firmness of the isthmus to obtain this compressibility. The firmly contracted uterus moves as one body and the sensation of lack of resistance is not felt. If the abdominal wall is firm, as is not uncommon in nulliparae, it is difficult to press the upper hand far enough down to obtain the sign. A thick abdominal wall or tender pelvic organs may also complicate the procedure. It is impossible to obtain the sign when the bladder is full. In the very early weeks of pregnancy (five to eight weeks) the uterus is as a rule more contractile and irritable than in the time following this, when the tissue is softer, the muscle flabbier
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