SIGNS AND SYMPTOMS OF PREGNANCY Pregnancy occurs between puberty and menopause(13 years to 45 years).However few authentic cases of pregnancy have been reported in children and women over 45 years.The youngest age of pregnancy reported so far is 5years 8 months from Peru (1939). Recently an occassional pregnancy has been induced in a perimenopausal women through IVF (in vitro fertilisation) programme,using a donor egg. The duration of pregnancy is calculated as 9 months 7 days from the first day of last menstrual cycle (280 days or 40 weeks).However labour can occur at any time 2 weeks earlier to EDD or may be delayed for few days.Thus duration of pregnancy is described as 40+_2weeks. For convenience period of pregnancy is divided in to trimesters,each trimester comprising 13 weeks or 3 months.
SIGNS AND SYMPTOMS IN FIRST TRIMESTER 1
.cessation of menstruation(amenorrohoea): In normally menstruating women,the abrupt cessation of cyclic and regular periods is strongly suggestive of pregnancy. But it is wise to wait for 7 days after the expected date of menstruation before considering pregnancy. FALLACY:Amenorrohoea can occur in the absence of pregnancy in certain pathological condition such as tubercular endometritis,metropathica haemorragica etc. Pseudocyesis is reported in some infertile women anxious to conceive.similarly some post menopausal women fear of pregnancy due to the development of symptoms of pregnancy such as distension of abdomen,heaviness in the breasts,nausea and vomitting. They mistake intestinal gurgling for the fetal movements.Clinical examination,pregnancy test and ultrasonography rule out pregnancy in such cases.
2
.Breast changes: Early in pregnancy,women experience heaviness,tingling,discomfort or tenderness in breasts. As pregnancy advances the breast enlarge ,feel nodular ,the areola and nipples enlarge and become more deeply pigmented. There will be often excretion of thin clear secretion from the nipples.Tiny protrubarances called “Montogmary tubercles” appear arround the nipples.
3.morning sickness: Most women especially primigravida (about 70%) experience some degree of nausea with or without vomitting usually in the early hours of the day. This lasts for few hours.There is no loss of apetite during the rest of the day and women remains well without dehydration and acidosis. Morning sickness is attributed to HCG hormone and changes in the general metabolism.It rarely lasts beyond first trimester.
4.frequency of micturition: The enlarging gravid uterus early in pregnancy exerts pressure on the bladder base causing frequent urination.This symptom generally relieved when the growing uterus becomes an abdominal organ but returns towards full term when the fetal head engages in the pelvis.
5.fatigue: Tiredness is an early symptom .some women complain of sleepiness and disinclination to work.This symptom often persists until mid pregnancy.
6.feeling of warmth and sweating: some women complain of feeling feverish and excessive sweating .This is due to altered circulation in the skin .
7.vaginal discharge : A whitish ,non offensive and non irritating mucoid discharge which is due to oestrogenic stimulation of endocervical mucosa.
Physical examination:
On examination ,the clinician can elicit signs which strongly endorse the suspicion of pregnancy.The enlarging gravid uterus is generally palpable above the pubic symphysis only after 12 weeks and reaches the level of the umbilicus by around 24 weeks. The breasts are enlarged ,become nodular and at times tender,veins may be prominent . At about 10th week, montogmary tubercles appear and by 12th week there will be pigmentation around nipples.A clear fluid can be expressed from the nipples and a few women develop brownish pigmentation over the forehead and cheeks ,known as chloasma.Chloasma disappear following delivery. Speculum examination reveals a bluish discoloration of vagina (Chadwick’s sign) and cervix (Jacquemier’s sign). A whitish mucoid discharge is seen in the vagina. Bimanual vaginal examination reveals soft cervix. Some times pulsations may be felt through the lateral fornix (Osiander’s sign).The uterus is soft (Goodell’s sign),enlarged and globular in shape . The uterine size corresponds to the period of gestation.The fornices are empty. Infrequent intermittent uterine contractions are felt in the first trimester (palmer’s sign).The uterus feels hard during contraction which lasts for 30 seconds and becomes soft again on uterine relaxation. On bimanual examination between 6th and 10th week of gestation,the cervix and the bulky uterus feel seperated (Hegar’s sign) As the pregnancy progresses the interval between the contractions becomes longer .Contractions (Braxton Hick contractions) are felt as a painless lightening of the uterus during the third trimester .During early pregnancy ,the pyriform shape of the uterus becomes globular.It is about the size of an egg at 6 weeks ,a cricket ball size at12 weeks .If there is an asymmetrical implantation,the consistency of the two halves of the uterus may be different giving the impression of an extra uterine mass( piskacek’s sign).