Signs and Symptoms of pregnancy •Objective Signs observed by the examiner

Presumptive Signs (Subjective) First trimester

- are signs that are least indicative of a pregnancy.
Goodell’s sign
Presumptive Signs
Chadwick’s sign
First Trimester
Hegar’s sign
Breast changes
Positive HCG
Urinary change
Second trimester
Fatigue
Ballottement
Amenorrhea
Enlarged abdomen
Morning Sickness
Braxton Hicks contraction
Enlarged uterus
Chadwick’s sign – bluish
Second Trimester discoloration of the vaginal wall
Chloasma Goodell’s sign is the softening
of the cervix.
Linea Nigra
Hegar’s sign is the softening of
Increase skin
the lower uterine segment.
pigmentation
Ballottement – sinking and
Striae
rebound of fetus
gravidarum
An evidence of a gestational sac
Quickening
found during ultrasound is
Presumptive Signs another probable sign.

1.Breast changes – Other possible causes are Braxton-Hicks contractions are

premenstrual changes and the use of oral painless and irregular
contraceptives. contractions at 28 weeks.
referred to as "false labor"
2.Urinary frequency – urinary tract infection may
also cause urinary frequency. The fetal outline can also be
now palpated by the examiner
3. Quickening * – other possible causes are through the abdomen.
intestinal gas, peristalsis
Chadwick’s sign – can also be
4.Increased skin pigmentation: chloasma, linea possibly caused by hormonal
nigra imbalance.

– Other possible causes are premenstrual changes Goodell’s sign – can also be
and the use of oral contraceptives. possibly caused by hormonal
imbalance.
5.Striae gravidarum
Hegar’s sign – can also be
* Chloasma or Melasma – mask of pregnancy possibly caused by hormonal
imbalance.
* Pregnancy stretch marks, also known as striae
gravidarum Positive HCG – Hydatidiform
Mole can cause a positive HCG
* Linea nigra– (Latin for "black line"), better known
as pregnancy line, line runs vertically along the Second trimester:
midline of the abdomen from the pubis to the
•Enlarged abdomen – could also
umbilicus. be caused by abdominal or
Probable signs uterine tumors
•Braxton hicks contractions –
presence of myomas can cause
false and painless contractions
•Ballottement – other possible
cause of this occurrence is the
presence of uterine or cervical
polyps.
The diagnosis of pregnancy cannot be solely made on the
presumptive or probable signs because they may have other
causes
Positive signs
•Undeniable signs confirmed by the use of instrument
•those than can be caused only by pregnancy.
FIRST TRIMESTER: Ultrasound evidence
SECOND TRIMESTER:
1. Fetal heart tones
2. Fetal movements
3. Fetal outline on xray
Normal Changes during pregnancy
PHYSIOLOGIC CHANGES
I. Local Changes– confined in the reproductive
organs (uterus, vagina, cervix)
UTERUS
• enlargement and thickening of the uterus most
marked in the fundus;
• 20 weeks AOG - at the level of umbilicus
• 36 weeks - xiphoid
• descends slightly during the last 3 weeks due to fetal
descent into the pelvis
• Hegar’s sign is the softening of the lower uterine
segment
CERVIX
• Becomes more vascular & edematous due to
increased circulating estrogen from the placenta.
• Soften in consistency (GOODELL’s sign); butter
soft; due to increased fluid between cells;
• Darken from a pale pink to violet due to increased
vascularity
• A tenacious coating of mucus fills the cervical canal;
mucous plug called Operculum; acts to seal out bacteria
and helps prevent infection in the fetus and membranes
VAGINA
• Bluish discoloration of the vaginal wall;
CHADWICK SIGN; due to increase in circulation.
• Vaginal secretions increase – whitish gray, moderate
in amount, mousy odor
(Leukorrhea); pH is 3.5 -6 because of increased
production of lactic acid
BREAST
• 1st physiologic change due to estrogen &
progesterone production (6 weeks)
• A feeling of fullness, tingling or tenderness in the
early weeks of pregnancy;
• the breast size increases a size or two, as the
mammary alveoli and fat deposits increase in size.
• The areola of the nipples become darker and its
diameter increases
• sebaceous glands of areola montgomery’s tubercles
enlarge; secretions from this glands keep the nipple
supple & help to prevent the nipples from cracking and
drying during lactation.
• colostrum present by 2nd trimester
OVARY
• ovulation cease throughout pregnancy
• On the first trimester in the ovaries, the corpus
luteum starts to become active. By the second trimester, it
begins to fade until the third trimester where it has already
disappeared.
• Amenorrhea also occurs, or the absence of
menstruation.
II. Systemic Changes – Entire Body
INTEGUMENTARY SYSTEM
1. STRIAE GRAVIDARUM- reddish, slightly
depressed streaks in the umbilical wall breast and thighs
due to the rupture of connective layer of the skin caused
by the stretching of the abdomen
2. LINEA NIGRA- line of dark pigment extending from
the umbilicus down the midline to symphysis
3. CHLOASMA – “mask of pregnancy” brownish
patches of pigment on the cheeks or nose.
4. Telangiectasis- is red, branching spots that can be
seen on the thighs.
- It is also called as vascular spiders, due to increased
estrogen level
5. Palmar erythema – redness and itching on the hands;
also occurs because of the increase in the estrogen
level of the pregnant woman.
RESPIRATORY SYSTEM
•Nasal Stuffiness due to increased estrogen levels
•Shortness of breath - Enlarging uterus elevates the diaphragm
(4cm)
•Hyperventilation occurs - Respiratory rate increased
•Thoracic cage expands
•The total oxygen consumption of a pregnant woman increases
by 20%.
CARDIOVASCULAR SYSTEM
•HEART – Heart is displaced upward by elevated diaphragm;
resulting to splitting of the first heart sound, with common
systolic murmurs.
•BLOOD VOLUME – cardiac volume increase by 30- 50%
causing an increase in cardiac output (cardiac output increases
when the woman turns from her back to her left side); 1,500
cc; 500cc for multiple pregnancy
•PULSE RATE- increase 10 -15 beats per minute during
pregnancy;
•BP - slight decrease in BP during first half of pregnancy
•Palpitations due to SNS stimulation; later months due to
increased thoracic pressure caused by pressure of the uterus
against the diaphragm.
•Easy fatigability due to increased cardiac workload
•Edema due to impaired blood flow to the lower extremities
due to the pressure of the expanding uterus on veins and
arteries.
Nsg. Intervention: Elevate legs above the hips level
•Varicosities
-wear support stockings
-elevate legs
•Vulvar varicosities
-due to pressure of gravid uterus
-side lying with pillow under the hips
-modified knee –chest position
•Plasma volume also increases up to 3600 mL faster than RBC
production marking the condition called Pseudoanemia early
in the pregnancy.
•Increase iron need about 800mg
-fetus requires 350-400mg of iron to grow
-mother needs 400 mg
-average mother’s iron store is less than 500mg
•iron absorption maybe impaired due to decreased gastric
acidity.
•Need for Folic acid
•Foods rich in folic acid – spinach, legumes
•Inadequate folic acid levels – neural defects in fetus
GASTROINTESTINAL SYSTEM
•Nausea and vomiting
- is one of the first signs of pregnancy that a woman feels.
-known as morning sickness; occurs early in AM on rising
-more frequent with those who smoke cigarettes
-due to increased HCG & progesterone
Nsg. Interventions:
Crackers 30 mins. before arising
Carb diet in AM
small frequent meal
•Heartburn - reflux of stomach content into the esophagus.
- progesterone relaxes the valve that separates the stomach
from the esophagus which makes it easy for gastric acids to
travel back up and cause heartburn.
-due to slow intestinal peristalsis & emptying time of the
stomach because of the pressure of the gravid uterus, pushing
the stomach and intestines toward the back & sides of the
abdomen
Hemorrhoids also occur from the increased pressure of the
uterus on the veins in the lower extremities.
- Hot sitz bath for comfort
•Flatulence
- due to increased progesterone, causes the muscles throughout
the body to relax. ... This allows gas to build up easier and
creates bloating, burping and of course flatulence.
-avoid gas forming foods
•Hyperptyalism
-increased salivation due to increased level of estrogen
-Mouthwash: to relieve aftertaste & acids in the oral cavity
URINARY SYSTEM
•The total body water of a pregnant woman increases up to 7.5
L for a more effective placental exchange.
•The bladder capacity increases to accommodate 1,000 mL of
urine during pregnancy.
•On the first trimester, the frequency of urination already
increases.
•2nd trimester - normal
•By the last two weeks of pregnancy it reaches up to 10 to 12
times per day.
•Normal = +1 sugar due to progesterone via benedict’s test
MUSCULOSKELETAL SYSTEM
•By the 32nd week of pregnancy, the symphysis pubis widens
for 3 to 4 mm.
•The ‘pride of pregnancy’ or commonly ‘lordosis’(forward
curve of the lumbar spine) occurs. To change her center of
gravity & make ambulation easier, a pregnant woman tends to
stand straighter and taller than usual and with the abdomen
forward and the shoulders thrown back causing backache
 Calcium & phosporous needs to be increased
because the fetal skeleton must be built.
-1 pint / day or 3-4 serving / day
-Cheese, yoghurt, head of fish, anchovies, broccoli, sardines
•Waddling gait
-awkward gait while walking
-prone to accidental falls
-wear low heeled shoes

•Leg cramps

-due to Ca-P imbalance during pregnancy

-Pressure on the lumbo sacral nerves by the gravid uterus

during labor

-dorsiflex the foot affected

-3-4 servings/ 4 cups/ day milk, sardines, dilis

TEMPERATURE

• Early in pregnancy - body temp. increases slightly

due to secretion of progesterone.

• At 16 weeks – temp decreases to normal when the

placenta takes over the function of the corpus luteum

The changes in the physiologic status of a pregnant woman are

just one of the many phases of changes that occur during
pregnancy.

• Most of these are normal, but when the pregnant

woman experiences an excessive manifestation of these signs,
it would be best to consult a healthcare provider