PISKACEK SIGN: WHAT IS IT, ANATOMY, GESTATION AND PREGNANCY - MEDICINE - 2025

The Piskacek sign refers to the asymmetry that the uterus presents in a gynecological physical examination and that alerts the doctor about the possibility of pregnancy in the examined woman. The asymmetry of the uterus is due to a change in consistency produced by the implantation of the embryo.

Normally the uterus has a firm consistency and its surface is completely smooth. When a change in these characteristics is noticed, it may be due to physiological effects of hormones during pregnancy. In other words, it is a sign that indicates the probability that the patient is pregnant.

By Ed Uthman, MD (Flickr, Wikipedia) - (2014). "Tubal pregnancy with embryo". WikiJournal of Medicine 1 (2): 7. DOI: 10.15347 / wjm / 2014.007., Public Domain, To notice the change in uterine consistency and asymmetry, the examining physician is required to have experience in palpating the uterus through the abdomen. Although the Piskacek sign gives a high suspicion of pregnancy, more in-depth examinations should be done to give a definitive diagnosis.

It should also be noted that the absence of this sign does not mean that the patient is not pregnant.

What is the sign of Piskacek?

The Piskacek sign is the asymmetry felt by the doctor in the uterus of a woman with suspected pregnancy, and which corresponds to the site where the embryo would be implanted.

By Entropy1963 - Own work, CC BY-SA 3.0, It was described by Ludwig Piskaçek (1854-1932) who was an Austrian obstetrician, author of numerous publications in the area of ​​obstetrics.

The maneuver consists of palpating the uterus abdominally. Under normal conditions, the uterus should feel smooth and firm-elastic in consistency. However, when there is a pregnancy, the implantation site is inflamed and creates a slight asymmetry. In addition, a change in consistency can be noticed in that place.

To recognize the sign, one must be trained in abdominal uterine palpation. It is an early sign that is around the fourth week of pregnancy. The absence of this sign does not exclude the probability of a pregnancy.

Anatomy

The uterus is an organ of great muscular content that is located in the female pelvis and is part of the internal genitalia of women. Its surface is smooth and has a firm-elastic consistency that is given both by its content of muscle fibers and by a large amount of collagen in its cells.

Collagen, which is found mixed between the muscle fibers in the uterus, is an element of great importance to achieve the growth of this organ during the development of the fetus in pregnancy.

Gestation and pregnancy

- Process

The fertilized egg is known as an embryo. The process by which this embryo develops within the uterus until the formation of the fetus is called gestation.

For its part, the term pregnancy refers to all the physiological changes that occur in a pregnant woman and that are intended for the fetus to develop within the uterus without complications.

The intrauterine development of the fetus lasts between 38 and 42 weeks. Once that time is complete, new physiological mechanisms are activated that trigger labor.

Pregnancy begins with the implantation or adherence of the embryo to the uterus and ends with the birth.

- Implementation

Implantation is a process in which the embryo adheres to the endometrial layer of the uterus, and invades the cells that make it up, beginning to elaborate the complicated maternal-fetal circulation network.

The implantation phase occurs only in the so-called implantation window, between days 16-22 of a 28-day menstrual cycle. It is in this period that the endometrium is receptive to the blastocyst or embryo.

But in addition to this, there must be adequate coordination between the hormonal, molecular and cellular parts that allow an adequate implantation process.

Implantation consists of three stages, the apposition stage, the adhesion stage, and the invasion stage.

In the apposition stage, the embryo lands on the implantation site within the endometrium. In the adhesion stage, the embryo's attachment to the endometrium begins by means of molecular products released by it. Finally, in the invasion stage, the embryo acquires the ability to release enzymes that break down the endometrial epithelium and penetrate the cell layer.

By Internet Archive Book Images - https://www.flickr.com/photos/internetarchivebookimages/14779613431/Source book page: https://archive.org/stream/diseasesofwomena01tait/diseasesofwomena01tait#page/n341/mode/1up, No restrictions, During the invasion stage, small bleeding may occur which is sometimes confused with normal menstruation.

- Signs and symptoms in pregnancy

First signs

When a woman of childbearing age has had unprotected sex, there is always the possibility of pregnancy.

The first thing the woman notices is the absence of menstruation. Especially when menstrual cycles are regular, this sign becomes important and is one of the main reasons why the patient consults a specialist.

Other nonspecific signs of pregnancy are morning sickness, tiredness or drowsiness, and sore breasts. All of these are called signs of probability, since based on their presence, the diagnosis of pregnancy cannot be assured.

Hormonal changes

During the physical examination, a medical specialist may notice other physical changes in the woman who suspects pregnancy. These changes are mediated by hormonal processes that are activated in pregnancy.

The hormones active during pregnancy trigger mechanisms that increase the amount of blood that reaches the uterus. This increase in the vascularity of the organ is the basis for almost all the physical changes that are observed.

The changes that occur in the uterus and the internal and external genital organs of women are known as the maturation process. Its objective is to ensure that the fetus can develop properly within the uterus, for the time necessary until it is ready for extra-uterine life.

The growth and change of consistency of the uterus, softening of the cervix, change in color of the vaginal mucosa and the skin of the vulva, are physiological variations that are frequently observed in pregnant women.

Probability signs

As well as nausea and all those imprecise signs that the woman notices, these are evidences that orient a little more the possibility of pregnancy but that are still signs of probability.

Probability signs only provide a degree of suspicion of pregnancy, but guide the doctor to request more in-depth examinations that can give the definitive diagnosis of pregnancy.

Medical exams

To diagnose a pregnancy, the presence of the fetus inside the uterine cavity must be evidenced. This is achieved through tests such as pelvic or transvaginal ultrasound and Doppler ultrasound, which is the test with which the fetal heartbeat is heard.

By Rizome - Own work, CC BY-SA 3.0, When tests show the presence of the fetus in the uterus, the pregnancy diagnosis is safe. These evidences are known as signs of certainty.

References:

1. Gossman, W; Fagan, SE; Sosa-Stanley, JN; et al. (2019). Anatomy, Abdomen and Pelvis, Uterus. StatPearls (FL). Taken from: ncbi.nlm.nih.gov
2. Su, R. W; Fazleabas, AT (2015). Implantation and Establishment of Pregnancy in Human and Nonhuman Primates. Advances in anatomy, embryology, and cell biology. Taken from: ncbi.nlm.nih.gov
3. Kim, S. M; Kim, JS (2017). A Review of Mechanisms of Implantation. Development & reproduction. Taken from: ncbi.nlm.nih.gov
4. Fowler, JR; Jack BW. (2019). Pregnancy. StatPearls (FL). Taken from: ncbi.nlm.nih.gov
5. 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