CLASSIFFICATION OF THE SIGNS OF PREGNANCY

• Presumptive signs

• Probable signs

• Positive signs

Presumptive signs of pregnancy
These are maternal physiological changes which a woman experiences and which in most cases indicate to her that she is pregnant. They are:

• Breast changes. like tingling, tenderness, enlargement

• Amenorrhea: Absence of menstruation/period.

• Nausea and vomiting(morning sickness)

• Colour changes of the cloasma.

• Appearance of the Montgomery’s tubercles.

• Colostrum expression

• Cloasma (pregnancy mask)

• Increased urine frequency

• quickening

Probable signs
These are maternal physiological changes other than presumptive signs which are detected upon examination and documented by the examiner.
These signs include:

• Jacquemeire’s sign/chadwicks sign (violet blue discoloration of the vaginal membrane due to increased vascularity)

  • Chadwicks Sign: Bluish discoloration on cervix, vagina, or labia resulting from increased blood flow. An early sign of pregnancy. May be observed as early as 6-8 weeks.

• Uterine changes (change in shape, size i.e. enlargement)

• Presence of HCG in blood (4th-12th) and in blood.

• Hegar’s sign (softening of the isthmus of the uterus)

• Braxton hicks contraction on palpation(16th week)

• Osiander’s sign(pulsation in the lateral fornices)

• Ballottement of the fetus (16th -28th week). This can be internal or external.

Positive signs
These are directly attributed to the fetus as detected and documented by the examiner.
They are:

• Visualization of the fetus by ultrasound scan (6th wk.)

• Visualization of the fetal skeleton by X-ray(16th week)

• Fetal heart sounds by ultrasound(6th week)

• Fetal heart sound heard with a fetoscope

• Palpable fetal movements (22wks)

• Visible fetal movements(late pregnancy)

• Palpation of the fetal parts (24th week)

CONCLUSION (on diagnosing pregnancy)
It should be noted that a number of the above signs should be considered before diagnosing pregnancy since there are other conditions which present with some of the above signs

MINOR ALMENTS/DISODERS OF PREGNANCY
The body goes through allot of un pleasant / or normal changes
Minor disorders

• Tiredness; in early and late pregnancy. due to extra weight mother is carrying
  -Treatment, rest, accept offers

• Constipation; Cause hormonal changes, (progestone)
  -Treatment
  -Eat plenty of fiber in diet e.g.
  -Exercise regularly (yoga and swimming) to keep muscle toned up
  Plenty of water, fluids and fruits.
  -Laxatives to stimulate the bowel into action.

• Headache; cause, hormonal changes
  Treatment

  • Rest and relaxation

  • A brisk walk may be all that you need
    Advice, it is wise to avoid drugs but some ocational cetamol can be used
    If headaches are not relieved by cetamol suspect high blood pressure.

• Faintness; Causes , poor supply of blood / or food to the brain
  -low oxygen levels

  • Hormonal changes

  • Too much lying at the back apart from supine hypotensive syndrome
    Treatment

  • Adjust the position, if standing sit

  • Reassurance
    -Try to get off slowly from where you are

• Ingestion; causes, Pregnancy hormones, leading to low peristaltic movement.

• The growing uterus presses on the stomach.
  Treatment
  -Try to eat smaller meals more often

  • Sit up straight when eating to relieve pressure off your stomach

  • Avoid particular foods that make symptoms worse like fatty and spiced foods.

• Heartburn; this is more than ingestion
  Cause, the cardiac reflux causes regurgitation of acid stomach contents due to that reflux.
  Treatment, sleep well dropped up (use pillows)

  • Try drinking a glass of milk

  • Avoid eating or drinking a few hours before sleep

  • Anti-acids can be taken to reduce reflux if contra indications are read

• Leaking from nipples; colostrum leaks in mid to late pregnancy
  Causes, hormones
  Management, do not squeeze them out
  -See Dr/ or midwife

  • Breast pad

• Backache; due to
  (i) Softened and stretched ligaments in preparation for labor.
  (ii) Lumber lordosis which puts a strain on the lower back and pelvis
  -Management, avoid lifting heavy load
  -Bend knees; keep back straight, when carrying something heavy.
  -Work at a surface high enough to avoid stooping
  -Balance weight to carry
  -Sit with back supported, use firm mattress

• Cramps; a sudden sharp pain on calf muscle and feet
  -Cause, pressure of the growing fetus compromising blood supply to the cuff muscles with minimal oxygen resulting to relies of lactic acid which causes pain during a contraction.
  Management, plenty of calcium rich foods eg vegetables, dairy products, sun flower seeds dried beans, magnesium rich foods
  -Elevating foot of bed
  -Exercises, particularly leg movement to aid circulation

• Pururitis valvae / itching
  Causes, increased blood supply to skin, stretching of abdominal skin
  -cholestasis (not common) due to a buildup of bile acids in blood
  Giant urticarial (large itchy red rash)
  Management
  Wear loose clothes, some medication to reduce bile acid level.

• Nose bleeds
  Cause, hormonal changes
  Treatment

  • Press sides of nose between thumb and fore finger for ten minutes

  • Avoid explosive sneezes

  • Try a steam inhalation.

• Frequency of micturition; early pre: developing and enlarging fetus
  Late: fetal head pressing bladder
  Try to find out how many times she empties the bladder in the night.

• Stress incontinency due to abdominal pressure and increased intra pelvic flow exercises

• Sudden spurt of urine when coughing, sneezing laughing
  Management reassurance, tighten up muscle around vagina

• Piles/ hemorrhoids swollen veins
  Cause, relaxed veins under the influence of progesterone
  Management, regular gentle exercise to improve circulation

  • Use of ice packs covered in clean cloth

  • If they stick out, observe infection prevention and push them back using a lubricant

• Respiratory distress; women feel breathless due to the growing uterus and as pregnancy advances
  Patient`s information, reassurance

• Ptyalism; increased salivation, it is due to failure of the mother to swallow
  Intervention
  Dental hygiene, ant cholinergic to induce dryness

• Symphysis pubis dysfunction

  • This is collection of discomfort and pain in the pelvic area radiating to the upper thighs and perineum.
    Management, pain relief, reassurance, resolves 6 months after delivery

• Peripheral paresthesia (tingling sensation of the fingers)
  Causes, fluid retention leading to compression of nerves
  It may often lead to carpal tunnel syndrome
  Interventions
  Wrist prints, steroid injection analgesics

• Insomnia / or sleeplessness
  Due to strange dreams, night mares about baby and birth, change in hormones
  Patient`s information
  Restful music before bed time, rest during the day, lie on one side with a pillow under your bump and on other between the knees

• Leucorrhea/Vaginal discharge
  Cause, hormonal changes, excess estrogen production
  It should be clear and smell unpleasant
  Intervention
  Use of loose cotton underwear
  Medication

• Varicose veins of the legs and vulva
  If severe rule out deep venous thrombosis
  Information

  • Avoid standing for long

  • Elevate legs, sit with legs crossed

  • Avoid putting on much weight

  • Exercise like walking

  • Support tights
    Others

• Nausea and vomiting, anticholinergic drugs can be prescribed to act on higher centres e.g. fenagan, plasil (metachromide) parentolite (multi vitamins), periactine dompeldol (motilium motinon).
  The side effects of the drugs are lack of concentration.

• Stretch marks (Striae gravidarum)

• Gingivitis; this is inflammation of the gum, mother`s information, hygiene is very important.

PHYSIOLOGICAL CHANGES DUE TO PREGNANCY (Relevant sections)

• CHANGES TO THE BREASTS (already detailed in Presumptive Signs)

• CHANGES IN THE UTERUS (Size, Weight, Position, Shape, Muscle coat, Upper/Lower segment, Endometrium, Myometrium, Perimetrium)

• THE CERVIX (Vascularity, Operculum, Show, Ripening)

• THE GROWTH OF THE UTERUS (Fundal height at different weeks)

• QUICKENING

• BRAXTON HICKS CONTRACTION

• THE VAGINA, VULVA AND PERINEUM (Blood supply, Colour, Mucus/Leucorrhea, Acidity)

• CHANGES IN THE INTEGUMENTARY SYSTEM (SKIN) (Sweat/sebaceous glands, Basal body temp, Striae gravidarum, Linear nigra, Chloasma)