HA

• Presumptive Signs of Pregnancy

  Signs which when taken as single entities, could easily indicate other conditions. They are experienced by the woman but cannot be documented by an examiner.
• Probable Signs of Pregnancy

  Objective signs which can be verified by an examiner. Although more reliable than presumptive symptoms, they still do not positively diagnose a pregnancy.
• Positive Signs of Pregnancy

  Truly reliable signs of pregnancy.
• Chorionic gonadotropin


  Hormone produced by the placenta that stimulates the ovaries to continue producing estrogen and progesterone
• Chorionic gonadotropin is produced


  No new eggs are released and no menstruation occurs
• Amenorrhea


  Absence of monthly menstrual flow
• Amenorrhea


  • Suppresses FSH - Ovum Maturation
• Breast Changes


  • Tenderness, fullness, enlargement, darkening of areola and nipples
• Nausea and Vomiting


  • Increase of HCG and Progesterone
• Frequent Urination


  • Growing fetus and abdomen pressing down the bladder
• Fatigue


  • Increase metabolic requirement, can increase the amount of morning sickness
• Uterine Enlargement


  • Increase the size of the fetus
• Quickening


  • Fetal movement felt by the mother at 16-20 weeks AOG
• Linea Negra


  • Line of dark pigmentation on the abdomen
• Melasma


  • Dark pigment on the face, also known as the chloasma mask of pregnancy. If found in other parts of the body such as the neck, armpit, nape the term used is Melasma.
• Striae Gravidarum


  • Stretch marks or streaks on the abdomen
• Positive Pregnancy Test for HCG Detection


  Test that can detect the hormone created by the chorionic villi of the placenta
• Chadwick's Sign


  • Vaginal discoloration: pink to purplish / bluish color
• Goodell's Sign


  • Softening of the cervix
• Hegar's Sign


  • Softening of the lower uterine segment
• Sonographic Evidence of Gestation

  • Ultrasound showing evidence of pregnancy
• Ballottement


  • When lower uterine segment tapped on bi-manual exam, fetus felt to rise on the abdominal wall
• Fetal Outline Felt by the Examiner

  • Palpation of fetal outline by the examiner at 28 weeks
• Fetal Heart Audible


  • FHR - normal: 120 - 160 beat/min, heard at 10-12 weeks using doppler, 18 - 20 weeks using stethoscope
• Fetal Movement Felt by the Examiner

  • Fetal movement felt by the mother at 16-20 weeks, felt by the examiner at 20 - 24 weeks
• Observation of overall health, emotional state, nutritional status, neuromuscular coordination provides useful information and helps put the patient at ease
• Discussion of the patient's priorities for the examination, responses to pregnancy, and general health
• Fundic Height


  Measurement of the height of the uterus fundus
• Blood Pressure


  Increase in BP suggests Pregnancy Induced Hypertension (PIH)
• Cardiac Rate and Respiratory Rate


  Sudden drop suggests bleeding
• Temperature


  Elevation suggests infection
• Weight Gain


  First Trimester: 0.4kg/1lb per month, Second Trimester: 0.4kg/1lb per week, Recommended total: 11.2 - 16 kg. Sudden increase suggests fluid retention or polyhydramnios, decrease suggests illness.
• BMI should be 19 - 25 for the pregnant state
• Chloasma (Mask of Pregnancy)


  • Irregular brownish patches around the forehead, cheeks, nose, or jaw
• Breast Size and Shape

  • Note any changes like increased size, firm tone, blue streaking of veins
• Nipples


  • Everted or inverted, may have colostrum discharge as early as 16 weeks
• Linea Nigra


  Black vertical line on the abdomen caused by increased melanin production
• Striae Gravidarum


  Stretch marks, a form of scarring on the skin with a silvery white hue
• Fundic Height Measurement


  Bartholomew's Rule: 12-14 weeks at symphysis pubis, 20-22 weeks at umbilicus, 36 weeks at xiphoid process, 40 weeks 4 inches below xyphoid (lightening)
• Leopold's Maneuver is a systematic palpation of the abdominal wall of the pregnant client (to be discussed in Lesson 3)