Determining an advanced pregnancy is as not difficult as determining the initial pregnancy, especially if the new patient is having late of menstruation for a period of a few weeks. This situation will be more difficult if the patient accidentally hides his pregnancy, such as unwanted pregnancy or vice versa in a very pregnant person.
Finally, it depends on the ability of midwives to recognize the signs and symptoms of pregnancy coupled with the interpretation of laboratory test results. Clinically, pregnancy signs can be divided into three major categories i.e. uncertain signs or probable signs, possibly pregnant, and definite signs of pregnancy.
- Uncertain sign
The signs of presumptive are a physiological change of a mother or a woman indicating that she was pregnant. Unexpected sign of pregnancy is an anatomic and physiological change apart from presumptive. This can be detected or recognized by the examiner. There are several signs characterized as uncertain signs. They are:
- Amenorrhea (late period of menstruation)
Pregnancy causes uterine wall (endometrium) is not released until amnorhea or no menstruation is considered as a sign of pregnancy. However, this can not be regarded as a definite sign of pregnancy since Amenorrhea can also occur in some chronic diseases, tumors-hypofise, changes in factors – environmental factors, malnutrition, and most often emotional disorders.
- Nausea and vomiting
Nausea and vomiting are common symptoms ranging from malaise to prolonged vomiting in medicine. This is known as morning sickness due to the emergence of frequent mornings. Vomiting nausea is exacerbated by smelly food and the unstable emotion of the sufferer. To overcome the sufferer should be given a mild, easy to digest food and explained that the condition is still within the normal limit of pregnant people.
The Mastodynia is a firmer and pain in the breasts caused by enlarged breasts. The vascularity is increased asinus and the ductus polyferated due to the influence of estrogen and progesterone.
Quickening is the perception of the first fetal movement usually noticed by women at 18 – 20 weeks of gestation.
- Urination Disorder
The frequency of urination is increased especially at night due to the insistence of the uterine dilation and pulling by the uterus to the cranial. It occurs in the first trimester and will relieve the second trimester. In the last trimester of this symptom is re-emerged because the fetus begins to enter the pelvic chamber and suppress the bladder back.
This constipation occurs because of the relaxing effect of progesterone or it can also be due to dietary changes.
- Change in body weight
At 2 – 3 months of gestation, weight loss often occurs due to decreased appetite and vomiting. In the following month, the weight will increase until stable before aterm.
- Skin color changes
These changes include chloasma which is blackish skin color on the forehead, back of the nose and skin of the cheekbones, especially in dark-skinned women. It usually appears after 16 weeks of pregnancy. In the area of the areola and breast nipples, the skin color becomes more black. All of these changes are caused by the stimulation of melanocyte stimulating hormone (MSH). On the skin of the abdomen and breasts can experience changes called striae gravidarum, later called changes such as scar tissue.
- Breast Changes
Breast enlargement is often associated with pregnancy, but this is not a sure indication.
Since there are similar conditions can occur in users of hormonal contraception, patients with brain or ovarian tumors, routine users of tranquilizers, and pseudocyesis. As a result of human placental lactogen, the breast secretes colostrum which is found usually in the period of more than 16 weeks’ gestation.
Cravings often occur in the first months. Pregnant women often ask for certain foods or drinks, especially in the first trimester. But it will disappear along with pregnancy.
Often found when pregnant women are in crowded places. It is recommended not to go to crowded places in the first months of pregnancy. However, this will disappear after 16 weeks of pregnancy.
This condition is caused by a decrease in the basal metabolic rate (BMR) in the first trimester of pregnancy. With increased fetal activity following the increase in gestational age, the fatigue that occurs during the first trimester will gradually disappear and the condition of the pregnant woman will be fresher.
- Varicose veins
This case is often found in the last trimester of pregnancy. It is can be found in the external genital area, popliteal fossa, foot and calf. In multigravida, sometimes varicose veins are found in previous pregnancies, reappearing in the first trimester. Sometimes the appearance of varicose veins is the first symptom of a young pregnancy.
- Constipation or obstipation
Appears because of the tone of the intestinal muscles decreases by the influence of steroid hormones
Epulis is papilla hypertrophy of gingivae. This often occurs in the first trimester.
- Signs – Possible pregnancy (Suspected of being pregnant)
- Changes in Uterus
The uterus normally changes in size, shape, and consistency. Also, it changes to a soft globular shape. Palpable balotemen, this sign appears at week 16-20, after the uterine cavity has obliterated and amniotic fluid is quite a lot. Balotemen is a sign that there are floating objects or floating in liquids
- Piskacek’s sign
The uterus enlarges to one direction until it stands out clearly into the direction of certain enlargement.
- Basal temperature
Basal temperature after uterine ovulation remains high between 37.20 – 37.80C. It is one of the signs of pregnancy. This symptom is often used in infertility examinations.
- Changes in the cervix
- Hegar sign
This sign is in the form of softening the uterine area of the uterus. The area in the pressure has a thinner impression and the uterus is easily reflected. Further, it can be identified through the bimanual examination. This sign starts to appear in week 6 and becomes evident at week 7-8.
- Sign of Goodell’s
Known through bimanual examination. The cervix feels softer. The use of oral contraceptives can also have this effect.
- Chadwick Sign
The presence of hypervascularization results in the vulva and vagina appearing redder, slightly bluish (lividea). This sign is called a Chadwick sign. The color of the portio seems as lividea. Blood vessels in the internal genital will enlarge. This is understandable because oxygenation and nutrition in the genital organs increases. If there is an accident in pregnancy or childbirth, then there will be a lot of bleeding, until it can cause death.
- Mc Donald Sign
The uterine and cervical fundus can be easily reflected with each other and depends on the softness or absence of the istmus tissue.
- Abdominal enlargement
Abdominal enlargement becomes clear after the 16th week of gestation. Since in this period, the uterus has come out of the pelvic cavity and become the abdominal cavity organ.
- Uterine contractions
This sign appears later and the patient usually complains of a tight stomach. This contraction is not accompanied by the pain.
- Examination of biological tests of pregnancy
On this examination a positive result, where the possibility of false positives.
- Signs of Definite Pregnancy
The exact sign of pregnancy is data or conditions that indicate the existence of pregnancy or fetus. That is known through examination and recorded by the examiner (fetal heart rate, fetal sonogram, and fetal motion). An indicator of the certainty of pregnancy is the discovery of the existence of the fetus clearly and this cannot be explained by other health conditions.
- Fetal Heart Rate (FHR)
It can be heard with a laenec stethoscope at week 17-18. In obese people, it will be slower. With an ultrasonic (doppler) stethoscope, FHR can be heard early around the 12th week of the pregnancy. Auscultation of the fetus can also identify other sounds such as cord noise, uterine noise, and maternal pulse.
- Movement of the fetus in the uterus
Movement of the fetus begins at 12 weeks gestation, but can only be felt by mothers at 16-20 weeks of gestation. At this period, pregnant women can feel smooth movements to the baby’s foot kick. The first baby movement that can be felt by the mother is called a quickening which is often interpreted as an impression of life.
Although, this initial movement can be categorized as a definite sign of pregnancy and estimated gestational age. However, it is often confused with bowel movements due to gas displacement within the gastrointestinal lumen. Baby body parts can also be easily palpated from 20 weeks’ gestation. Phenomenal pendulum or back reflection called a ballottement is also a sign of a fetus in the uterus.
- Braxton-Hicks marks
If the uterus gets the stimulation, it will be easy to contract. This sign is typical for uterus during pregnancy.