Pregnancy may be suspected in any sexually active woman, of childbearing age, whose menstrual period is delayed, particularly if combined with symptoms of early pregnancy, such as:

• Nausea (1st trimester)

• Breast and nipple tenderness (1st trimester)

• Marked fatigue (1st and 3rd trimesters)

• Urinary frequency (1st and 3rd trimesters)

• The patient thinks she's pregnant

Early signs of pregnancy may include:

• Blue discoloration of the cervix and vagina (Chadwick's sign)

• Softening of the cervix (Goodell's sign)

• Softening of the uterus (Ladin's sign and Hegar's sign)

• Darkening of the nipples

• Unexplained pelvic or abdominal mass

Pregnancy should be confirmed with a reliable pregnancy test. Urine or serum pregnancy tests can be used. Both are reliable and detect human chorionic gonadotropin (HCG). Pregnancy is considered present if 30-35 mIU of HCG are present in the urine or serum.

Ultrasound may be used to confirm a pregnancy, if the gestational age is old enough for visualization of a recognizable fetus and fetal heartbeat. In that situation, a confirmatory HCG is not necessary.