History

The majority of women have amenorrhea from the last menstrual period until after the birth of their baby.

Symptoms

Although not specific to pregnancy, these symptoms may alert the patient to the fact that she is pregnant :

• Breast enlargement and tenderness from about 6 weeks gestational age.
• Areolar enlargement and increased pigmentation after 6 weeks gestational age.
• Colustrum secretion may begin after 16 weeks gestational age.
• Nausea with or without vomiting, from about the date of the missed period.

• Urinary frequency, nocturia, and bladder irritability due to increased bladder circulation and pressure from the enlarging uterus.

Signs

Some clinical signs can be noted, but may difficult to quantify :

• Breast enlargement, tension, and venous distention
• Bimanual examination reveals a soft, cystic, globular uterus with enlargement consistent with the duration of pregnancy.
• Chadwick’s sign : Bluish discoloration of vagina and cervix, due to congestion of pelvic vasculature.

Pregnancy Testing

How ?

The beta subunit of human chorionic gonadotropin (hCG) is detected in maternal serum or urine.

• hCG is a glycoprotein produced by the developing placenta shortly after implantation.
• A monoclonal antibody to the hCG antigen is utilized.

When ?

• Blood levels become detectably elevated 8 to 10 days after fertilization ( 3 to 3.5 weeks after the LMP ).
• hCG rises in a geometric fashion during T1, producing diferent ranges for each weeks of gestation.

Fetal Heart Tones

The electronic Doppler device can detect fetal heart tones as early as 8 weeks gestational age

Ultrasonic scanning

When ?

• To confirm an intrauterine pregnancy.
• To confirm the presence of a fetal heartbeat in a patient with a history of miscarriage.
• To diagnose multiple pregnancy.
• To estimate gestational age.
• To screen for fetal structural anomalies.