Presumptive Signs
  • Amenorrhea – for 3 consecutive mos.
  • Breast Changes – nipples larger and more pigmented; breast may be enlarged w/ more prominent veins; small elevations on the areola may appear (Montgomery’s Tubercles)
  • Skin Pigmentation
    • Melasma/Chloasma – brownish facial pigmentation
    • Linea Nigra – dark vertical line on the abdomen below xiphoid process
    • Striae Gravidarum – stretch marks that appear on abdomen, buttocks, thighs
  • Nausea and Vomiting – “morning sickness”, 2-6 weeks after conception and may disappear at the end of the 1st trimester, caused by rising levels of hCG
  • Fatigue
  • Frequency of Urination – caused by pressure of the expanding uterus on the urinary bladder
  • Enlargement of Abdomen – noticed around 12 weeks due to expanding uterus
  • Quickening – sensations of fetal movement
 Probable Signs
  • Hegar’s Sign – softening of lower uterine segment
  • Chadwick’s Sign – bluish/purplish discoloration of the vagina
  • Goodell’s Sign – softening of the cervix
  • Braxton-Hicks Contractions – “false labor”, periodic uterine tightening
  • Ballottement – sinking and rebounding of fetus in surrounding amniotic fluid in response to palpation
  • Positive for hCG – during urine or blood test
  • Sonographic Evidence of Gestational Sac - not totally positive; may be indicative of hydatidiform mole
  • Fetal Outline Felt by Examiner
Positive Signs
  • Fetal Heart Tones
    • 18-20 weeks by fetoscope
    • 10-12 weeks by Doppler stethoscope
  • Fetal Movement Felt by Examiner
  • Sonographic Evidence
 Psychologic Maternal Changes
  • Ambivalence – mixed emotions, fear and excitement
  • Emotional Liability – frequency of changes in emotional state, mood swings
  • Body Image Changes – changes in woman’s perception of her body image, may be positive or negative
  • Introversion and Passivity – needs to rest and do quiet things
  • Primary Narcissism – causes woman to consider her own needs
Physiologic Maternal Changes
  • Other than the presumptive, probable and positive signs, other changes include:
    • Formation of OPERCULUM (vaginal plug near the cervix)
    • Cessation of oogenesis
    • Change in center of gravity
    • Decreased bladder capacity and tone
    • Hemorrhoids
    • Ptyalism (excessive salivation)
    • Gum tissue may swell and easily bleed
    • Increased O2 requirements
    • Supine Hypotension Syndrome
    • Increased circulation
  • First Trimester
    • N/V – dry crackers, avoid empty or full stomach, increase protein intake
    • Frequent Urination – Kegel’s exercises
  • Second Trimester
    • Spider Nevi – avoid prolonged standing
    • Leukorrhea – use sanitary pads
  • Third Trimester
    • Shortness of Breath – good posture and rest
    • Braxton-Hicks Contractions – rest, breathing, ambulate
    • Leg Cramps – ambulate
    • Ankle Edema – elevate hips and legs
    • Supine Hypotension Syndrome – side lying position during sleep
Care for a Pregnant Mother
  • Increase Fe, Ca, Folic Acid intake
    • Iron - increased O2 requirement and blood levels due to growing fetus
    • Calcium - to avoid growing fetus from drawing calcium from mother's bones
    • Folic Acid (Vit B9) - prevents neural tube defects
  • Wear a support bra
  • Nap/rest every AM/PM
  • Medium to low heel shoes
  • Avoid prolonged standing
  • No constrictive clothing
  • Wear cotton underwear
  • Regular breast care
  • Left side-lying position when lying down
  • Regular exercise
  • Dry crackers for N/V
Prenatal Check-Up Schedule
  • Every 4 weeks for the 1st-32nd week
  • Every 2 weeks for the 32nd-36th week
  • Every week for the 36th week up to delivery
Psychological Tasks of the Mother
  • 1st Trimester – accepting the pregnancy
  • 2nd Trimester – accepting the baby
  • 3rd Trimester – preparing for parenthood
Cervical Consistency
  • Not pregnant – feels like the tip of nose
  • Pregnant – feels like earlobes
  • About to give birth – feels like butter


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