The sign Goodell refers to the change of consistency of the cervix that evidence physician on physical examination of a woman gynecological, when suspected pregnancy. The cervix or cervix is a part of the uterus that the specialist can touch through intravaginal palpation in the gynecological physical examination.
Under normal conditions, the cervix is firm in consistency, it feels like touching the tip of the nose. However, in pregnant women, from the first 4 weeks, it can feel tender, as soft as touching the lips.
By Henry Vandyke Carter - This is a retouched picture, which means that it has been digitally altered from its original version. Modifications: vectorization (CorelDraw). The original can be viewed here: Gray1167.png. Modifications made by Mysid., Public Domain, This change in consistency is one of the first signs of probability of pregnancy that the doctor may find before conducting more in-depth tests that ultimately lead to the diagnosis of pregnancy.
As gestation time passes, other changes occur in the anatomy of the uterus. All these physiological changes occur in order to keep the fetus in a mature state until the moment of its expulsion through the birth canal.
What is the Goodell sign?
Goodell's sign consists of a change in the consistency of the cervix. It can be felt by the gynecologist specialist in the intravaginal palpation of the cervix. It was described by the American gynecologist William Goodell (1829-1894), who was a professor at the University of Pennsylvania.
The change in consistency that occurs occurs because during pregnancy the circulation of blood in the uterus increases, which guarantees a good nutritional supply for the unborn child.
Once the process of increasing vascularity begins, the uterus begins to grow, especially in the cervix. This process causes the collagen fibers to elongate and form a much more elastic tissue.
Thus, when the doctor feels the surface of the cervix, he feels a soft tissue and not a firm tissue as is felt in women who are not pregnant.
Associated signs
Just as the Goodell sign is a probable determinant of pregnancy, there are some other signs related to it that guide the specialist towards the diagnosis of pregnancy.
Some of these signs are the following:
- Noble-Budin sign: the enlarged uterus can be felt through vaginal examination.
- Hegar's sign: the uterus feels soft on its entire surface.
Anatomy
The uterus or womb is an organ that is located in the female pelvis. It is totally dependent on hormones and is part of a woman's internal genital tract. Its main function is to receive the fertilized ovum for the gestation of the fetus.
By OpenStax College - Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013., CC BY 3.0, Anatomically, the uterus consists of a broad fundus, a neck, and an isthmus or body that unites these two portions. The cervix extends into the vagina and opens through an external opening.
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The uterus is made up of muscle fibers and fibro-elastic tissue with a high content of collagen, which gives it a firm consistency. The body of the uterus is made up of three layers:
- Serosa or perimetrium: outermost layer.
- Myometrium: middle layer. It is the muscular layer of the organ, it is responsible for contraction in labor.
- Endometrium: it is the deepest layer, very rich in blood vessels. It is the one that prepares the bed for the implantation of the fertilized ovum.
The uterus receives an important supply of blood from the uterine arteries and veins. Your circulation increases during pregnancy, and this increase is responsible for some of the anatomical changes that occur during pregnancy, such as softening of the cervix (Goodell's sign).
Pregnancy
The term pregnancy refers to all the physiological changes that occur in the woman so that she can maintain and cope with the pregnancy. Examples of these changes are the enlargement of the uterus and the preparation of the mammary glands for lactation.
For its part, the term gestation is the development of the fetus within the uterus. Gestation begins when the embryo implants in the uterus and ends with birth.
Pregnancy consists of three periods of three months each or trimesters. When the woman begins the third trimester, the fetus is already viable to live outside the uterus.
Physiology
Pregnancy begins when the embryo, which is the egg fertilized by the sperm, implants itself in the deep layer of the uterus, the myometrium. There it receives adequate blood nutrition to continue its development.
Once this occurs, a series of physiological changes begin in the woman that are intended to keep the fetus in the uterus until the moment of birth. A full pregnancy lasts between 38 and 40 weeks.
From Miraceti - Freely according to images at, CC BY-SA 3.0, Among the most important changes that the pregnant woman presents, is the increase in the size of the uterus and the variations in the consistency of this organ that allow the fetus to develop and grow properly.
Changes in the size and consistency of the uterus occur due to a modification in collagen fibers, both in the fundus and in the cervix and the uterine body. This whole process is mediated by hormones.
The fundus of the uterus becomes soft and growth begins as the fetus grows. The cervix also takes on a softer consistency and as time goes by it shortens its length and dilates to allow birth.
Diagnosis
Within the diagnosis of pregnancy there are signs of certainty and signs of probability. The signs of certainty are those that ensure the diagnosis of pregnancy. Meanwhile, the signs of probability are the changes that can be found in a pregnant woman and that guide the diagnosis, but do not ensure that the patient is pregnant.
Probability signs give a high degree of suspicion of pregnancy and based on these signs, a series of tests are carried out to help the doctor confirm the diagnosis.
The signs of certainty are:
- Pelvic ultrasound that shows the presence of the fetus in the uterus.
- Fetal heart activity. It is a type of examination with which the heart of the fetus is listened to.
From Guimi - http://guimi.net Own work, CC BY-SA 2.5, Signs of suspicion are based on the symptoms and physical examination of the woman who suspects pregnancy. From these signs the doctor begins a clinical investigation to determine the state of pregnancy.
The patient may refer symptoms such as absence of menstruation, nausea, especially in the morning, breast pain and fatigue. In addition to these, there are signs in the physical examination that the doctor can show and that are of high probability for a pregnancy diagnosis.
Some of these signs are:
- Goodell's sign
- Contractions
- Uterine growth.
References
- Gossman, W; Fagan, SE; Sosa-Stanley, JN; et al. (2019). Anatomy, Abdomen and Pelvis, Uterus. StatPearls (FL). Taken from: ncbi.nlm.nih.gov
- Fowler, JR; Jack BW. (2019). Pregnancy. StatPearls (FL). Taken from: ncbi.nlm.nih.gov
- Rådestad, A. (1992) Cervical Softening in Early Pregnancy. Drife JO, Calder AA Prostaglandins and the Uterus. Springer, London
- Motosko, CC, Bieber, AK, Pomeranz, MK, Stein, JA, & Martires, KJ (2017). Physiologic changes of pregnancy: A review of the literature. International journal of women's dermatology. Taken from: ncbi.nlm.nih.gov
- Akins, M. L; Luby-Phelps, K; Bank, R. A; Mahendroo, M. (2011). Cervical softening during pregnancy: regulated changes in collagen cross-linking and composition of matricellular proteins in the mouse. Biology of reproduction. Taken from: ncbi.nlm.nih.gov