ASSESSING THE PREGNANT WOMAN

Presumptive (Subjective) Symptoms

 which could easily indicate other conditions
 taken as single entities

 Breast changes – feelings of tenderness, fullness, tingling, enlargement and darkening of the areola
 Nausea, vomiting
o arising when fatigued
o known as morning sickness as levels of hCG and progesterone begin to rise
 Amenorrhea – absence of menstruation
 Frequent urination – sense of having to void more often
 Fatigue – general feeling of tiredness
 Uterine enlargement – uterus can be palpated over symphysis pubis
 Quickening – fetal movement felt by woman
 Linea nigra – line of dark pigment forms on the abdomen
 Melasma – dark pigment for on face
 Striae gravidarum – stretch mark form on abdomen

Probable (Objective) Symptoms

 can be verified by an examiner

 Maternal serum test – a venipuncture of blood serum reveals the presence of human chorionic gonadotropin
hormone
 Chadwick’s sign – color change of the vagina from pink to violet
 Goodell’s sign – softening of the cervix
 Hegar’s sign – softening of the lower uterine segment
 Sonography evidence of gestational sac – characteristic ring is evident
 Ballottement – when lower uterine segment is tapped on a bimanual examination, the fetus can be felt to rise
against the abdominal wall
 Braxton Hicks contractions – periodic uterine tightening occurs
 Fetal outline felt by examiner – fetal outline can be palpated through abdomen

Laboratory Tests
 the use of a venipuncture or a urine specimen to detect the presence of human chorionic gonadotropin (hCG)

hCG
 a hormone created by the chorionic villi of the placenta, in the urine or blood serum of the pregnant woman
 only 95% to 98% accurate so results are considered as probable rather than positive

In non-pregnant woman, no units of hCG will be detectable because there are no trophoblast cells producing hCG.

In pregnant woman, trace amounts of hCG will appear in her serum as early as 24 to 48 hours after implantation and
reach a measurable level.

Positive Finding
 Sonographic evidence of fetal outline
o fetal outline can be seen and measured by sonogram
 Fetal heart audible
o doppler ultrasound reveals heartbeat
 Fetal movement felt by examiner
o fetal movement can be palpated through abdomen

Positive Signs of Pregnancy

1. demonstration of a fetal heart separate from the mother’s
 o fetal heart cannot be heard through an ordinary stethoscope until 18 to 20 weeks
o an echocardiography can demonstrate a heartbeat as early as 5 weeks
o an ultrasound can reveal a beating fetal heart as early as 6 th to 7th week of pregnancy
o doppler instrumentation (converts ultrasonic frequencies to audible frequencies) is able to detect fetal
heart sounds as early as the 10th to 12th week of gestation
o normal fetal heart rate – 120-60 bpm
o polyhydramnios – a larger-than-normal amount of amniotic fluid present
2. fetal movements felt by an examiner
o fetal movements may be felt by a woman as early as 16 to 20 weeks
o objective examiner can discern fetal movements at about 20 th to 40th week of pregnancy
3. visualization of the fetus by ultrasound
o ultrasound – the most common method for confirmation of pregnancy today
o if a woman is pregnant, a characteristic ring (indicating the gestational sac), will be revealed on an
oscilloscope screen as early as the 4th to 6th week of pregnancy

Physiologic Changes of Pregnancy

Location of Change First Trimester Second Trimester Third Trimester

Cardiovascular  blood volume blood pressure slightly blood pressure returns to
increasing decreased prepregnancy levels
 pseudoanemia may
occur
 clotting factors
increasing
Ovarian uterine  corpus luteum  corpus luteum steady increased growth
active fading
 steady increased  placenta producing
growth estrogen and
progesterone,
steady increased
growth of ovarian
uterine
Cervix softening begins softening increases “ripe”
Vagina white discharge present increasing in amount
Musculoskeletal  progressive
cartilage softening
 lordosis increasing
 progressively
increasing
Pigmentation  progressively possible back or pelvic
increasing girdle pain
Kidney  maternal
glomerular
filtration rate
increasing
 glycosuria begins
and increases
 aldosterone
increased, aiding
retention of sodium
and fluid
Gastrointestinal slowed peristalsis
Thyroid increased metabolic rate