Amniotic fluid embolism

Understanding Woman’s Period: Pregnancy, Signs and Diagnosis 

Definition of Pregnancy

This refers to the condition of having a developing embryo or fetus within the body; the state from conception to delivery of the fetus.

Pregnancy

Medically, it is defined as the union of male and female gametes to zygote which would further undergoes serial cell divisions and be transferred to uterus for implantation and further growth and development. It’s otherwise called conception, gestation or fertilization,

The normal duration is 280days (40 weeks or 9 months and 7days) counted from the first day of the last normal menstrual period.

Diagnosis of Pregnancy

Signs and symptoms of pregnancy are divided into three categories which are:

  • Subjective or presumptive changes
  • Objective or probable changes
  • Diagnostic or positive changes

Subjective (Presumptive changes) signs

Presumptive signs of pregnancy are symptoms the woman experiences and reports. They can be caused by other conditions, so they cannot be considered  as true proof of pregnancy. They include:

  1. Amenorrhoea (absence of menses): missing menstrual period is the earliest symptom and a useful diagnostic clue. Alternative causes are early menopause, emotional shock(owing to disappointment in love affairs, stress/death of beloved, infection, pseudocyesis  (intense desire for pregnancy), severe anaemia, severe malnutrition, or change of residence.
  2. Nausea and vomiting:This occurs during the 1st trimester with the onset from 4-8 weeks’ gestation and lasting until 16-20 weeks.This is commonly called morning sickness because they occur in the early part of the day. Women who experience nausea and vomiting often have a more favourable pregnancy outcome. Alternative causes of nausea and vomiting during pregnancy are GIT disorder, anorexia nervosa, encephalitis, and pseudocyesis.
  3. Excessive Fatigue: This is noticed during the first few weeks of pregnancy and may persist throughout the first trimester.  Its alternative causes: too much stress, malaria and typhoid fever.
  4. Urinary frequency: This occurs during conception because the enlarging uterus pressing on the urinary bladder. Alternative causes of urinary frequency apart from pregnancy are urinary tract infection (UTI), cystocele, pelvic tumor and emotional tension.
  5. Changes in the breasts: These changes in breasts during pregnancy are caused by hormones of pregnancy such as estrogen and progesterone produced by the placenta. These changes include:
  • Tenderness and tingling sensation
  • Increased pigmentation of areola and nipple
  • Visible vein that form bluish pattern beneath the skin
  • Alternative changes are premenstrual tensions and pseudocyesis. 
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6. Quickening: Qickening simply means the mother’s perception of fetal movement. It occurs about 18-20 weeks after the last menstrual period (LMP) in primiparous (a woman in her first pregnancy) and as early as 16weeks in a woman that has been pregnant before (multipara).

For the sake of examination and quick remembrance, the subjective signs of pregnancy can be summarized by this acronym, “ANC-QUE”: 

A: Amenorrhea

N: Nausea and vomiting

C: Changes in breasts

Q: Quickening

U: Urinary frequency

E: Excessive Fatigue

Objective (probable) signs of pregnancy

These are non-sensitive indications of conception. They  involve changes in the pelvic organs due to increased vascular congestion. They include:

Goodell’s signs: softening of the cervix occurring at about six to eight weeks of gestation. 

Chadwick sign: Bluish, purple or deep red discoloration of the mucous membrane of the cervix vagina and vulva.

Hegar’s sign:  flexing the body of the uterus against the cervix (i.e. softening of the cervix and the uterine isthmus, occurring at six to 12 weeks of gestation.

McDonald’s sign: This is an ease in flexing the body of the uterus against the cervix.

Alternative causes are vascular congestion and  oral contraceptives

Enlargement of the abdomen 

 If it is continuous and accompanied by amenorrhea during the child bearing years, pregnancy might not be the cause. Obesity, ascites, pelvic tumors are alternative causes

Braxton Hicks Contractions

This is common after the 28 weeks of gestation. Towards term, it may become uncomfortable and is known as false labor. These Braxton Hicks contractions are nature’s way of stimulating or training the uterus for the essential functions it would perform during the time of delivery or labour.

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Uterine Souffle:

It’s heard during auscultation on the abdomen. It is a soft blowing sound that occurs at the same rate as the maternal purse caused by the increased uterine blood flow and blood pulsating through the placenta.

Alternative causes are large uterine myomas, large ovarian tumors.

Changes in pigmentation of the skin

These changes include:

  • Nipples and areolas may darken.
  • Linea nigra may develop; that is the darken line that runs from the umbilicus upwards in the stomach of a pregnant woman.
  • Facial melasma (chloasma).
  •  Striae may appear.
  • Alternative causes are estrogen progesterone or contraceptives

Foetal outline:

  • May be identified by palpation after 24 weeks gestation.
  • Alternative causes are uterine myomas.

Ballottement:

It is the passive fetal movement elicited when the examiner inserts two gloved fingers into the vagina and pushes against the cervix. This action pushes the fetal body up and as it falls back, the examiner feels a rebound.

Alternative causes are uterine tumors, polyps, ascites and others.

Pregnancy Tests:

This detects the presence of HCG (human chorionic gonadotropin) in the maternal blood or urine. Alternative causes are choriocarcinoma, menopause, and hydatidiform mole.

Pregnancy

Diagnostic (positive) signs of pregnancy:

 Diagnostic  signs are completely objective and cannot be confused with a pathologic state. They offer conclusive proof of pregnancy. The positive or confirmatory signs of pregnancy which  the midwife can trust are:

  1. The fetal heartbeat:

This can be detected with an electronic Doppler device as early as weeks 10 to 12th gestation.

  1. Fetal movement:

This is palpable by a trained examiner or midwife after about the 20-22th week.

  1. Visualization of the fetus:
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The gestational sac can be observed by 4-6 weeks gestation with aid of ultrasound scan and other imaging techniques that are not detrimental to pregnancy. Fetal parts and movements can be seen as early as 8weeks. Gestational sacs can be detected as early as 10days.

  1.  Palpation of fetal parts from 24th week’s gestation. 

 The skillful and experienced midwife can palpate fetal parts during abdominal examination. 

Conclusion

In summary, if you notice any of these signs and symptoms related to pregnancy, it is good that you see your doctor prompt ly. This is early antenatal booking helps to save both mother and baby from complications of pregnancy.   If you have questions, feel free to reach me. Thanks for reading.