EARLY PREGNANCY, SIGNS AND SYMPTOMS, LANDMARKS

Note: Pregnancy is  dated in weeks, starting from the first day of the last normal menstrual period.

IF the periods were regular and IF ovulation occurred on day 14 of the cycle, she  is  two weeks pregnant when the next period is due to occur, but obstetric dates are  2 weeks longer than the pregnancy itself actually  exists (IE two weeks after missing a period, the patient is considered to be 6 wk pregnant, even though it is only 4 weeks after conception).

Signs and symptoms, 4 to 6 weeks after LMP –

The first sign is usually a missed menstrual period. Missing a period for >= 1 wk is presumptive evidence of pregnancy if a woman has regular periods and is sexually active

Breast engorgement may appear very early (caused by increased levels of estrogen (primarily) and progesterone and is an exaggeration of premenstrual breast engorgement.

 WISE WORDS “Morning sickness may appear early especially if a woman greatly desires – or fears to be – pregnant”

MORNING SICKNESS  may be caused by human chorionic gonadotropin (hCG) and estrogen, which the developing placenta starts to produce about 10 days after fertilization.

May feel sleepy and  fatigued.

Increased urination.

May find clothes tight; feels “bloated” very early – even before uterus enlarges (exaggeration of PMS type symptoms)

Pelvic examination at 6 plus weeks: uterus is larger, The cervix is softer (it feels like a pair of lips rather than a nose). The cervix usually becomes bluish to purple

Hegar’s sign the uterus can be easily flexed at  the soft isthmus at 6 wk of pregnancy,

Chadwick’s sign or Jacquemier’s sign – darkening or blue color of vaginal mucus membranes – at 8 weeks

Darkening of areola – breast tenderness 6 to 8 weeks

Uterine enlargement – rough gauge --  7 weeks size of an egg. 10 weeks size of an orange, 12 weeks size of a grapefruit, 20 weeks size of a large cantaloupe

Internal  ballottement – 14 weeks. With your fingers on the cervix, you can feel the baby drop down onto your fingers when you gently tap upwards (CONCLUSIVE SIGN)

External ballottement – 24 weeks

Quickening (fetal movements) 16 to 18 weeks

palpable fetal movements – (movements felt by others) 20 weeks, by touch or ear

At 12 wk, the uterus can be felt above the symphysis pubis. At 20 wk, it reaches the navel and measures APPROXIMATELY 20 cms from the fundus to the symphysis; At 36 wk, the upper pole is near the xiphoid process (and about 36 cms).

Positive proof of pregnancy = fetal heart sounds via  Doppler at 8 to 10 wks or  20 to 24 weeks with a stethoscope. Fetal movements felt or heard by the examining midwife.

Pregnancy averages 266 days from the time of conception or 280 days from the first day of the last menstrual period if periods are regular at 28 days.

 Nägele's rule calculates the Estimated Delivery  Date. Add 7 days to the LMP and subtract 3 months (more easily done if you use numbers for the month)> About  50% deliver within 1 wk and almost 90% within 2 wks of this date.  Labor at 42 weeks is common, especially for first time pregnancies (primiparous women)

Gravida (latin for pregnant)  a first time pregnant (gravid) woman is gravida 1. Each pregnancy (multiple gestation is one pregnancy) increases gravidity.  

Parity (latin for birth) describes outcome. Para counts deliveries after 20 wk, which are numbered  as para 1, 2, 3, etc (multiple pregnancies are only 1 para). Abortus refers to losses before 20 wk, which are numbered the same. The sum of para and abortus equals gravidity.  

Alternate method.

Para is recorded in 4 numbers: The first indicates the number of term deliveries (after 37 wk); the 2nd, the number of premature deliveries (> 20 and < 37 wk); the 3rd, the number of abortions or miscarriages; and the 4th, the number of living children.

Example: A pregnant woman with one prior term delivery, one set of twins born at 32 wk, and two abortions is gravida 5, para 1-1-2-3. The other method would term this woman as G5 Para 3 or G5P3.