PRESUMPTIVE SIGNS AND SYMPTOMS OF PREGNANCY
Presumptive signs and symptoms of pregnancy are those signs and
symptoms that are usually noted by the patient, which impel her to make an
appointment with a physician. These signs and symptoms are not proof of
pregnancy but they will make the physician and woman suspicious of pregnancy.
a. Amenorrhea (Cessation of
(1) Amenorrhea is one of the earliest clues of pregnancy. The
majority of patients have no periodic bleeding after the onset of pregnancy.
However, at least 20 percent of women have some slight, painless spotting
during early gestation for no apparent reason and a large majority of these
continue to term and have normal infants.
(2) Other causes for amenorrhea must be ruled out, such as:
(b) Stress (severe emotional shock, tension, fear, or a
strong desire for a pregnancy).
(c) Chronic illness (tuberculosis, endocrine disorders, or
central nervous system abnormality).
(e) Excessive exercise.
b. Nausea and Vomiting (Morning
(1) Usually occurs in early morning during the first weeks of
(2) Usually spontaneous and subsides in 6 to 8 weeks or by the
twelfth to sixteenth week of pregnancy.
(3) Hyperemesis gravidarum. This is referred to as nausea and
vomiting that is severe and lasts beyond the fourth month of pregnancy. It
causes weight loss and upsets fluid and electrolyte balance of the patient.
(4) Nausea and vomiting are unreliable signs of pregnancy
since they may result from other conditions such as:
(a) Gastrointestinal disorders (hiatal hernias, ulcers, and
(b) Infection (influenza and encephalitis).
(c) Emotional stress, upset (anxiety and anorexia nervosa).
c. Frequent Urination.
(1) Frequent urination is caused by pressure of the expanding
uterus on the bladder.
(2) It subsides as pregnancy progresses and the uterus rises
out of the pelvic cavity.
(3) The uterus returns during the last weeks of pregnancy as
the head of the fetus presses against the bladder.
(4) Frequent urination is not a definite sign since other
factors can be apparent (such as tension, diabetes, urinary tract infection,
d. Breast Changes.
(1) In early pregnancy, changes start with a slight, temporary
enlargement of the breasts, causing a sensation of weight, fullness, and mild
(2) As pregnancy continues the patient may notice:
(a) Darkening of the areola--the brown part around the
(b) Enlargement of Montgomery glands--the tiny nodules or
sebaceous glands within the areola.
(c) Increased firmness or tenderness of the breasts.
(d) More prominent and visible veins due to the increased
(e) Presence of colostrum (thin yellowish fluid that is the
precursor of breast milk). This can be expressed during the second trimester
and may even leak outin the latter part of the pregnancy.
(3) These breast changes can be more positive if the patient
has not recently delivered and is not presently breastfeeding.
e. Vaginal Changes.
(1) Chadwick's sign. The vaginal walls have taken on a deeper
color caused by the increased vascularity because of increased hormones. It is
noted at the sixth week when associated with pregnancy. It may also be noted
with a rapidly growing uterine tumor or any cause of pelvic congestion.
(2) Leukorrhea. This is an increase in the white or slightly
gray mucoid discharge that has a faint musty odor. It is due to hyperplasia of
vaginal epithelial cells of the cervix because of increased hormone level from
the pregnancy. Leukorrhea is also present in vaginal infections.
f. Quickening (Feeling of Life).
(1) This is the first perception of fetal movement within the
uterus. It usually occurs toward the end of the fifth month because of
(a) A multigravida can feel quickening as early as 16 weeks.
(b) A primigravida usually cannot feel quickening until
after 18 weeks.
(2) Once quickening has been established, the patient should
be instructed to report any instance in which fetal movement is absent for a
(3) Fetal movement early in pregnancy is frequently thought to
g. Skin Changes.
(1) Striae gravidarum (stretch marks). These are marks noted
on the abdomen and/or buttocks.
(a) These marks are caused by increased production or
sensitivity to adrenocortical hormones during pregnancy, not just weight
(b) These marks may be seen on a patient with Cushing's
disease or a patient with sudden weight gain.
(2) Linea nigra.
(a) This is a black line in the midline of the abdomen that
may run from the sternum or umbilicus to the symphysis pubis.
(b) This appears on the primigravida by the third month and
keeps pace with the rising height of the fundus.
(c) The entire line may appear on the multigravida before
the third month.
(d) This may be a probable sign if the patient has never
(3) Chloasma. This is called the "Mask of Pregnancy." It is a
bronze type of facial coloration seen more on dark-haired women. It is seen
after the sixteenth week of pregnancy.
(4) Fingernails. Some patients note marked thinning and
softening by the sixth week.
h. Fatigue. This is a
common complaint by most patients during the first trimester. Fatigue may also
be a result of anemia, infection, emotional stress, or malignant disease.
i. Positive Home Test.
These tests may not always be accurate, however, they are very effective today
if they are performed properly.