Obstetric Topic 09. Signs and symptoms of pregnancy

I. Presumptive Signs

Subjective Suspicion

• Presumptive signs: subjective symptoms suggesting pregnancy; nonspecific.
• Nausea and vomiting / morning sickness.
• Amenorrhea: common first clue, but can have non-pregnancy causes.
• Breast tenderness, fatigue, urinary frequency, food aversion/craving.

II. Probable Signs

Examination and Test Findings

• Probable signs: objective findings observed by examiner/test, but not direct proof of fetus.
• Positive urine/serum β-hCG: probable, not definitive; rare false positives/GTD/recent pregnancy possible.
• Enlarged uterus.
• Breast engorgement: pain, enlargement, increased vascularization.
• Goodell sign: softening of cervix.
• Hegar sign: softening/compressibility of lower uterine segment/cervical isthmus.
• Chadwick sign: bluish discoloration of cervix/vagina due to vascular congestion.
• Osiander sign: pulsation felt over the fornices.
• Piskacek sign: asymmetric uterine enlargement / soft prominence at implantation site.

III. Positive / Definitive Signs

Direct Fetal Evidence

• Positive signs: direct detection of the fetus.
• Visualization of embryo/fetus by ultrasound.
• Fetal heart activity by ultrasound.
• Fetal heart tones by Doppler/fetoscope later in pregnancy.
• Fetal movement seen on ultrasound or palpated by examiner.
• Maternal quickening alone is supportive, but less definitive than examiner/US confirmation.