Presumptive Vs Probable Vs Positive

In the world of Obstetrics, there are three stages of pregnancy confirmation: presumptive, probable, and positive. Believe it or not, a "pregnancy test" as we know it is not a positive (or conclusive) test; it only gives you a probable result. Here are some examples of the signs of pregnancy confirmation, and what other factors might be causing them:

Presumptive signs of pregnancy

·         Missed period  - Sorry, but if you’re 60 and you missed your period….probably not pregnant

·         Nausea / vomiting - Really? You thought eating sushi from the gas station was a good idea?

·         Weight gain – Are you American? Enough said. (But sadly…we’ve finally been dethroned of having the honor of fattest country in the world! Thanks a lot Mexico…)

·         Fatigue – Bad news, you’re not pregnant….more bad news, you have Lupus…

·         Breast Tenderness – You got a little out of control after reading 50 shades of grey…baby steps.

·         Quickening (A “flutter” of movement…when mom says, “I think I just felt the baby move!”) – Please refer back to gas station sushi. This can be gas or peristalsis.

Probable signs of pregnancy

• Hegar's sign (softening of lower uterus), Goodell’s sign (softening of cervical tip), or Chadwick’s sign (vaginal mucosa turns violet-blueish) – I hope you aren’t basing your results after any of these, because they require palpation and some spelunking! So probably not things you would want to do at home. However, if you are, all of these things can be caused by pelvic congestion. 
• Ballottment (By far my favorite!! This is when the examiner places a finger within the vagina, taps gently upward against the cervix, and leaves their finger there. This causes the free floating fetus to rise, only for gravity to make it sink back down, and the examiner feels a light tap on her/his finger….how cool is that?! It's not really used any more, but still very cool.) – Not sure what else could cause this. My nursing textbook claims it could be cervical polyps…but I’m thinking maybe a marble got up there somehow? 
• Braxton-hicks contractions – Sadly, these can be caused by a tumor. 
• Urine pregnancy test – The at home classic! The problem is, a pregnancy isn’t the only thing that can cause a positive. Pelvic infections, tumors, and simple user error can lead to false positives.
• Serum pregnancy test – This is the one we in the surrogacy world all depend on! We get our Beta HcG levels, we compare how they change, and if they rise appropriately, surely we know we have a baby on the way, right? Nope. A molar pregnancy (caused by a hydatidiform mole, or a large mass, growing in the uterus) can also be the culprit. Also, a non-viable pregnancy can also cause these levels to rise. 

And this is where we are currently in our journey. We’ve gotten the coveted positive on the serum pregnancy test…and we’re over the moon thrilled. Our beta levels showed significant rise going from 120 on the first test, to 1793 on the second test that was taken just less than a week after the first. This means that the levels are doubling in less than 48 hours, and that seems to be highly desirable. The likelihood of anything but a viable pregnancy causing the beta levels to rise like that is really very low, and that feels amazing.

 But, we’re not letting our guard down just yet. It’s not until we get to the third stage of pregnancy confirmation that we’ll be able to relax knowing without a doubt that we have a viable pregnancy. And that third stage comes within the next week. For us, it will be an ultrasound to detect the heartbeat. Nothing else in this beautiful world can mimic that little flutter of a heartbeat within the womb, and so it is accepted as a Positive sign of pregnancy. Here are the other methods of solidly confirming a pregnancy:

Positive signs of pregnancy  (The only ways to be 100% certain that you have a pregnancy and nothing else could possibly be causing a positive.)

• Ultrasound to visualize fetus in real time or detect fetal heart tones.
• Doppler to detect fetal heartbeat.
• Fetal movements palpated by nurse, nurse midwife, midwife, PA, or physician (Interestingly, movements felt by the mother don’t count. It sounds crazy, but one of the last case studies we had involved a woman with a psychosomatic pregnancy, or a pregnancy manifested only in her mind, right down to distended belly and her claims of feeling fetal movement. Very interesting stuff.)
• Fetal movements visible through the abdomen (Not even the dreaded gas station sushi could do that!)

By this time next week, we should hopefully have a positive confirmation of our pregnancy. It’s amazing how much your life can change in one short week.

Here’s hoping for the best.