Department of Obstetrics & Gynecology Symptoms and signs of pregnancy Dr. Dina Nawfal Department of Obstetrics & Gynecology College of Medicine University of Mosul

Symptoms and signs of pregnancy Early symptoms of pregnancy amenorrhea urinary frequency breast engorgement nausea tiredness & easy fatigability abdominal enlargement  

Amenorrhea: In a woman that menstruate regularly when her period suddenly stopped means that she is pregnant till proved otherwise Amenorrhea does not have the same significance in case of a woman with irregular period , nor in a menopausal woman Pregnancy can occur in a young girl before menarche & it can arise during a period of amenorrhea, e.g. during lactation or following discontinuation of oral contraception  

Frequency of micturition During the first 12 weeks , frequency of micturation develops because the enlarging uterus press on the bladder specially on standing Breast symptoms: In the early weeks of pregnancy some tenderness and fullness of the breast may be noticed.   Nausea and vomiting: Termed as morning sickness, mostly due to the effect of the hCG on the maternal chemoreceptor triggering zone it will be more evident in pregnancy complicated by high level of hCG as in pregnancy with hydatidiform mole , it usually decreases or even disappear after the first trimester

Dizziness and fatigability Due to high estrogen level, low glucose level, low blood pressure Abdominal enlargement With the progression of pregnancy the uterine enlargement become evident on abdominal examination ( uterus become palpable abdominally after 12 week of pregnancy ) sometimes it is first sign that bring the patient to the doctor specially in women with irregular cycle

Signs of pregnancy Signs due to changes in the uterus Enlargement of the uterus Early uterine enlargement tend to be in the A-P diameter so that the uterus becomes globular. Softening of the uterus and cervix Softening of the uterus due to increase it's vascularity as uterine consistency becomes softer , it may be possible to palpate or to compress the connection between the cervix and fundus (Hegar’s sign)

Cervical changes Softening and blue discoloration of the cervix soon follow the softening of the uterus and are usually complete by the 16th week Progressive enlargement of the uterus By the 12th week the fundus of the uterus is usually palpable in the abdomen just above the symphysis pubis The fundus reaches the level of the umbilicus at about the 22nd week Uterus is just below the xiphisternum at the 36 week

Fundal height when it is larger than date found in cases of multiple pregnancy, polyhydromnions, fibroids and at a lower level than expected with a transverse lie , an abnormal growth retarded , oligohydromnions or dead fetus Painless contractions : From early in pregnancy the uterus has an intermittent painless contractions ( Braxton Hicks contractions) it begins usually at 12 weeks gestation.

Signs due to the presence of the fetus: Ballottement : demonstrated during the bimanual exam. at the 16th to 20th week . Ballottement is when the lower uterine segment or the cervix is tapped by the examiner's finger and left there , the fetus floats upward, then sinks back and a gentle tap is felt on the finger.

Fetal heart sounds: On auscultation of the abdomen with a sonicaid the fetal heart sounds may be heard after the 12th week Palpation of the fetal parts Abdominal palpation of fetal parts is usually possible from the 24th week onwards , and the recognition of the different fetal part later on is an absolute sign of pregnancy

Signs due to changes in the breasts and the skin: breast changes primary areola secondary areola Montgomery tubercules Colostrum Skin changes Chloasma linea nigra striae gravidarum

Laboratory tests for pregnancy These depend on the detection of hCG levels in maternal plasma and its excretion in urine urine pregnancy test: usually positive on day 35 from the last menstrual period ( 7 days after the last menstrual period ) Serum pregnancy test ; usually positive 7-10 days after conception.

Imaging test to confirm the pregnancy Ultrasonographic recognition of the fetus: By the transvaginal ultrasound After 5 weeks amenorrhea the gestational sac appear as a small , fluid filled structure . surrounded by echogenic rim of tissue.

By the 6th week the embryo appear within the gestational sac . After 6th week the Fetal heart activity become evident The trans abdominal us delayed by about 1 week than the trans vaginal us.

Pregnancy dating: The estimated date of delivery ( EDD ) is a 9 calendar months and 7 days from the LMP (Naegel’s rule) In order to calculate the gestational age by this method the woman should have regular menstrual cycle Should not be lactating Not on contraception

Pseudocyesis Is a psychological disorder in which the woman has a false but fixed idea that she is pregnant It is frequently seen near or after the menopause , and also in infertile women There may be amenorrhea , and the woman may declare that she has morning sickness and breast enlargement , and that she can feel fetal movements.

The abdomen may appear distended , either by air collected in the stomach or by intestinal distension , or exaggerated lumber lordosis or sometimes just by fat. The shape of the swelling is not that of the pregnant uterus , fetal parts cannot be felt and the fetal heart cannot be heard . A pregnancy test or ultrasound scan will be required but the difficulty is to convince the woman that she is not pregnant.

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