Symptoms

Secondary amenorrhoea

This is the earliest symptom . If a female in the reproductive age presents with missed periods, she is perceived as pregnant till proved otherwise. Diagnosis of pregnancy only by this symptom will become difficult if a female gets pregnant while she's in lactational amenorrhoea. And infrequently there can be bleeding per vagina up to 3 months of being pregnant till mixture of decidua vera with decidua capsularis takes place. This bleeding is different to that of menstrual bleeding in amount and colour. Therefore when inquiring about the last menstrual period it's very important to inquire about whether it was similar to her previous menstrual period. It is also important to inquire whether she had been on ordinary contraceptives as it could also affect the regularity of the menstrual cycle.

Nausea

This is the commonest symptom being present in approximately seventy-five to eighty percent of expecting mothers. They will present with symptoms like nausea, barfing, faintishness and fatigue which should start around 5th to 8th week of pregnancy and become maximum around 10th week then settles by 12th to 14th week. The development of the symptoms follows the hCG curve. Therefore these symptoms are believed to be linked with the increased levels of hCG hormone.

If the symptoms are dreadful enough to affect day to day activities of the girl it is critical to disallow medical, surgical and gynecological causes which will cause these symptoms.

E.g : Hyperemisis “viral hepatitis, intestinal obstruction, pyelonephritis

The time of appearance of the above symptoms can be used to get a concept about the period of gestation so that a crude prediction of the predicted date of delivery can be determined.

Increased frequency of micturition

This is due to pressure by the enlarged anteverted uterus, increased vascularity of the bladder and stretching of the lower part of the bladder by the enlarging cervix. If show includes features evidential of other pathologies such as diabetes mellitus and urine canal diseases one needs to be totally analyzed.

Breast discomfort

There'll be sense of fullness, tingling sensation and discomfort in the bazongas which starts around 6th to 7th week of pregnancy. This is typically due to raised estrogen level causing fluid retention and distention of the juggs. It is important to ask about the breast symptoms, as these tend to vanish in the event of a missed miscarriage.

Abdominal enlargement

This may be only mild as the uterus is still a pelvic organ in the 1st trimester. Expansion of abdomen is due to relaxation of intestinal smooth muscles under the influence of progesterone. Bloated feeling whinged by lot of females is thanks to the generalized liquid retention under the influence of steroid hormones secreted when pregnant.

Marks

Critical signs that help in diagnosis of pregnancy are detected in the funbags and pelvis.

Breast

There's increased pigmentation around the nipple leading to formation of primary areola around 1st to 2nd month of being pregnant (in primi mothers) which should then endure thru out life. There will also be enlargement of sebaceous glands leading to formation of Montgomery tubercles around the nipple.

Pelvic examination

Jacquemier’s sign

There is bluish discoloring of the vestibule and the anterior vaginal wall due to increased vascularity seen around 8th week of pregnancy.

Cervical changes

Before pregnant firm cervix become soft by about 42nd day of the wonderful pregnant period. On inspection there is a bluish discoloration of the cervix due to hyperaemia.

Osiander’s sign

During per vaginal exam increase palpitation is felt in the lateral fornices around 8th week of pregnancy due to increased blood flow through the uterine arteries.

Hegar’s sign

This alludes to the sensation experienced by the fingers in bimanual exam, of virtually meeting. This is due to the extreme softening of the isthmus of the uterus around 6th to 10th week of pregnancy.

Uterine enlargement

On bimanual examination uterus is felt to be enlarged “by 8th week its size is about that of a lime. By about 12th week it is enlarged to the dimensions of a grape fruit and can be palpated just above the symphysis pubis. This will not be possible if the uterus is retroverted.

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