Pregnancy Symptoms Overview

Fatigue

• During the first trimester, fatigue is common due to the uterus pressing on the bladder
• Fatigue can also be caused by anemia, infection, emotional stress or malignant disease
• Fatigue subsides as the pregnancy progresses and the uterus rises out of pelvic cavity

Breast Changes

• Breast changes can be the first notable sign of pregnancy
• The breasts will start to enlarge, feel heavier, full and experience mild tingling
• Changes include the darkening of the areola, enlargement of Montgomery glands, prominent and visible veins
• Colostrum can be expressed during the second trimester and may leak out in the latter part of the pregnancy

Vaginal Changes

• An increased white or slightly gray mucoid discharge with a faint musty odor is known as leukorrhea
• Leukorrhea is due to hyperplasia of vaginal epithelial cells of the cervix due to increased hormones
• It can also be caused by vaginal infections

Quickening

• This involves the mother's first perception of fetal movement within the uterus
• Typically occurs towards the 18th week of pregnancy

Probable Signs Of Pregnancy

• Signs that are commonly noted by a physician upon examination of the patient
• The physician will look for uterine changes, abdominal changes, cervical changes, basal body temperature, and a positive pregnancy test
• The physician will also look for fetal palpation

Uterine Changes

• By the 12th week, the uterus rises above the symphysis pubis and should reach the xiphoid process by the 36th week of pregnancy
• The uterus increases in width and length approximately 5 times its normal size
• The uterus's weight increases from 50 grams to 1,000 grams

Hegar's Sign

• This is the softening of the lower uterine segment just above the cervix
• The Hegar’s sign can be noted by the 6th to 8th week of pregnancy

Ballottement

• This can be demonstrated during a bimanual exam from the 16th to 20th week of pregnancy
• Ballottement involves the lower uterine segment or the cervix being tapped by the examiner's finger and left there.
• The fetus floats upward, then sinks back, and a gentle tap is felt on the finger.

Cervical Changes

Goodell's Sign

• This is the marked softening of the cervix, which is normally firm like the cartilage at the end of the nose.
• It is present at 6 weeks of pregnancy

Formation of a Mucous Plug

• It forms due to hyperplasia of the cervical glands as a result of increased hormones
• It serves to seal the cervix of the pregnant uterus and protect it from contamination by bacteria in the vagina

Braxton-Hick's Contractions

• These are painless uterine contractions that occur throughout pregnancy
• They usually begin around the 12th week of pregnancy and become progressively stronger
• Generally, they cease with walking and do not cause the cervix to dilate

Positive Pregnancy Test by the Physician

• Even if the test is positive, it can indicate an ectopic pregnancy or a hydatidiform mole.

Fetal Outline Palpation

• The physician can palpate the abdomen and identify fetal parts
• This is not always accurate as a sign of pregnancy

Positive Signs Of Pregnancy

• These are signs that are definitely confirmed as a pregnancy

Palpation Of Fetal Movement

• This is done by a trained examiner
• It is easily elicited at the 20th-24th week of pregnancy

Ovarian Changes

• Cessation of ovulation occurs
• The woman might feel tingling, fullness or tenderness in her breast due to high estrogen
• The breast size increases and the areola of the nipple darkens and its diameter increases from 3.5 cm to 5 or 7.5 cm.

Montgomery’s Tubercles

• The sebaceous glands of the areola become enlarged and protuberant, which keeps the nipple supple and helps to prevent nipples from cracking and drying during lactation.

Systemic Changes

Gastrointestinal System

• Heartburn (pyrosis) occurs due to a reflux of stomach contents into the esophagus and a relaxed cardioesophageal sphincter caused by relaxin and progesterone
• Flatulence and constipation occurs because of the slow emptying time of the stomach and slow intestinal peristalsis
• Nausea and vomiting are due to decreased glucose levels, a relaxed cardioesophageal sphincter caused by relaxin and progesterone, and increased hCG, estrogen and progesterone levels
• Hyperptyalism, an increase in saliva formation, is a local response to increased levels of estrogen
• Subclinical jaundice is caused by decreased emptying of bile from the gallbladder which leads to reabsorption of bilirubin into the maternal bloodstream causing generalized itching
• Increased tendency to stone formation occurs due to additional cholesterol incorporated in bile

Cardiovascular System

• Increase in blood volume occurs to provide for an adequate exchange of nutrients in the placenta
• Plasma volume increases faster than RBC, causing a decline in the concentration of hemoglobin and erythrocytes, which may result in pseudoanemia
• The pregnant woman will need additional iron (400mg) to accommodate the increased RBC in her circulation, along with 350-400 mg of iron for the growth of the fetus. The total requirement for iron during pregnancy is 800mg.
• A lack of folic acid can result in an increased risk for neural tube disorders in fetuses.
• Spinach, asparagus, and legumes are high in folic acid
• Peripheral blood flow increases by up to 40%.
• Oxygen consumption increases by 20% because of the demands of the fetus

Mild Hyperventilation

• This is a result of blowing off excess CO2 being shifted to the mother by the fetus

Temperature

• Progesterone causes a slight increase in temperature

Hormones

• hCG is secreted by trophoblast cells of the placenta in early pregnancy
• hPL is an antagonist to insulin which allows more glucose to become available for fetal growth. High levels of hCG, estrogen, and progesterone contribute to this.
• Relaxin is secreted primarily by the corpus luteum. This hormone softens the collagen in joints and the cervix and inhibits uterine activity.
• Prostaglandins affect smooth muscle contractility. They may be the trigger that initiates labor at term.
• The pituitary gland increases production of GH and MSH. Oxytocin is produced by the posterior pituitary gland late in pregnancy, and it is important for aiding in labor

Changes in the Breasts

• The breasts increase in size and feel tender or full, with tingling
• The areola darkens and its diameter increases
• The sebaceous glands, called Montgomery’s tubercles, become enlarged and protuberant, which keeps the nipple supple preventing cracking and drying during lactation

Vaginal Changes

• As the vaginal walls thicken, increased discharge in the vagina occurs
• The vaginal environment becomes acidic due to an increased concentration of glycogen
• This favors the growth of Lactobacillus acidophilus (Doderlein bacillus) which helps produce lactic acid

This quiz covers common symptoms experienced during pregnancy, including fatigue, breast changes, vaginal changes, and quickening. It provides insights into what mothers can expect as they progress through their pregnancy trimesters. Understand the physiological changes and what they signify for maternal health.