Volume 1

A treatise on the science and practice of midwifery / by W.S. Playfair.

Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the science and practice of midwifery / by W.S. Playfair. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    199/442 (page 171)
    Chap. V.] DIFFERENTIAL DIAGNOSIS OF PREGNANCY. character of the tumour is not unlike tliat of the gravid uterus. The best safeguard against mistakes will be the pre- vious history of the case, which will always be differeut from that of ordinary pregnancy. Retention of the menses almost always occurs from some physical obstruction to the exit of the fluid, such as imperforate hymen; or if it occur in women who have already menstruated, we may usually trace a history of some cause, such as inflammation fol- lowing an antecedent labour, which has produced occlusion of some part of the genital tract. The existence of a pelvic tumour in a girl who has never menstruated will of itself give rise to suspicion, as pregnancy under such circumstances is of extreme rarity. It will also be found that general symptoms have existed for a period of time considerably longer than the supposed duration of pregnancy, as judged of by the size of the tumour. The most characteristic of them are periodic attacks of pain due to the addition, at each monthly period, to the quantity of retained menstrual fluid. Whenever, from any of these reasons, suspicion of the true character of the case has arisen, a careful vaginal examina- tion will generally clear it up. In most cases the obstruc- tion will be in the vagina, and is at once detected, the vaginal canal above it, as felt per rectum, being greatly distended by fluid; and we may also find the bulging and imperforate hymen protruding through the vulva. The absence of mammary changes, and of ballottement, will materially aid us in forming a diagnosis. The engorged and enlarged uterus, frequently met with Conges- in women suffering from uterine disease, might readily be ti-gphy^'^of mistaken for an early pregnancy, if it happened to be asso- the uterus, ciated with amenorrlioea. A little time would, of course, soon clear up the point, by showing that progressive increase in size, as in pregnancy, does not take place. This mistake could only be made at an early stage of pregnancy, when a positive diagnosis is never possible. The accompanying symptoms—pain, inability to walk, and tenderness of the uterus on pressure—would prevent such an error. Ascites, jier se, could hardly be mistaken for pregnancy ; Ascitic for the uniform distension and evident fluctuation, the ab- orlhT' sence of any definite tumour, the site of resonance on per- abdomen, cussion changing in accordance with alteration of the position