A woman’s body goes through drastic physiological changes from the day she conceives to weeks after the delivery of her baby. It is important to differentiate the physiological changes of pregnancy from other pathological conditions. This section will discuss signs and symptoms that are indicative of pregnancy.
Cessation of menses: Pregnancy is highly likely if 10 or more days have passed from the time of expected menses in a woman who previously had regular cycles.
- Increase breast tenderness.
- Increase in breast size.
- Nipples become larger, more pigmented, and more erectile.
- Areolae become broader and more pigmented.
- Colostrum may be expressed from the nipples.
- Striations on the skin.
- Striae gravidarum (aka stretch marks): Reddish, slightly depressed streaks on the abdomen, breast, and thighs.
- Linea nigra: Midline of the abdominal wall becomes darkly pigmented.
- Chloasma or melasma gravidarum (aka mask of pregnancy): Irregular brown patches of varying size on the face and neck.
- Angiomas: Red elevation at a central point with branching vasculature present on the face, neck, chest, and arms due to estrogens.
- Palmar erythema.
- On bimanual exam, the uterus feels soft and elastic.
- The uterus ↑ in size throughout the pregnancy (its size correlates to gestational age). By week 12, it is about the size of a grapefruit and the fundus of the uterus becomes palpable above the pubic symphysis .
Cervical changes: Cervix becomes softer.
Changes in cervical mucus: Cervical mucus can be dried on a slide and evaluated via microscope.
Fernlike pattern: Not pregnant—estrogen effect.
Beaded or cellular pattern: Pregnant—progesterone effect.
Vaginal mucosa discoloration: With pregnancy and increase blood flow, the vagina appears dark bluish or purplish-red.
Perception of fetal movement: A primigravida may report fetal movement at approximately 20 weeks gestation, and a multiparous at 18 weeks gestation.
Nausea and/or vomiting (aka morning sickness): Nausea and/or vomiting occurs in approximately 70–85% of pregnancies, most notably at 2–12 weeks gestation. It frequently occurs in the morning, but it can occur through out the day. Hyperemesis gravidarum is persistent vomiting that typically occurs early in pregnancy. When severe, it can result in weight loss, dehydration, acidosis (from starvation), alkalosis (from loss of HCl in vomitus), and hypokalemia.
Hair growth changes: Prolonged anagen (the growing hair phase).
Fetal heart rate (FHR) detection (discussed later in this chapter).
Urologic changes: ↑ pressure from the enlarging uterus result in increase urinary frequency, nocturia, and bladder irritability.