Piskacek's sign
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In medicine, Piskaček's sign is a physical indication of pregnancy.
It is defined as asymmetry of the enlarged uterus, palpable during pelvic examination, after the first few weeks of pregnancy. It is attributed to lateral implantation of the embryo, which can enlarge one uterine horn before the other.[1][2] It has also been described as focal softening of the uterus, contrasted to the firmness of the area where the placenta is implanted.[3]
It is named after obstetrician Ludwig Piskaček (pronounced PIS-ka-check), who described it in Vienna in 1899, though it had already been noted by Robert Latou Dickinson of New York in 1892. A similar physical sign had been described by Carl von Fernwald Braun.[2] It comes from an era when laboratory tests for pregnancy had not been developed, but experience gained in pelvic examination during early pregnancy by western gynecologists led them to publish their physical findings, allowing clinical diagnosis of pregnancy.[3] Other such signs of early pregnancy include Goodell, Hegar, Hartman and Chadwick signs.
Early methods for detecting pregnancy primarily relied on physical examinations, these findings were often subjective and unable to include later stages of gestation.[3] Piskaçek's sign, introduced in 1899 by Ludwig Piskaçek's described the asymmetric enlargement of the uterus that occurs when the embryo implants on one side, which could be felt during a pelvic examination.[3] While useful and clinically valuable at the time, this technique was limiting and varied in reliability.
Development of biochemical testing and laboratory diagnostics have since changed early pregnancy detection. Modern medical advances have allowed for biochemical imaging technologies to be more sensitive and accurate when testing for signs of pregnancy.[3] Modern tests identify the hormone human chorionic gonadotropin(hCG) in urine or blood, allowing for pregnancy to be detected as early as 9–10 days before ovulation or before a missed menstrual period.[4] Due to blood based hCG testing having higher sensitivity, it can also allow tracking for early pregnancy progression. Continuing research on reproductive biomarker in both humans and animals have continued to improve accuracy of early pregnancy diagnosis.[5]
Advances in medical imaging have further strengthened the capabilities to detect early signs of pregnancy. The creation of transvaginal ultrasonography allows clinicians to visualize the gestational sac at approximately 4–5 weeks gestation.[6] Ultrasounds provide a more clear and direct way to visually confirm signs of early pregnancy, enabling early assessment of location and developmental progress. Biochemical testing and ultrasound technology have since replaced traditional physical sign techniques like Piskaçek's sign in routine clinical practice.[7]