Pregnancy is divided into 3 trimesters

o First
1-12 weeks
weight gain 1-2 kg
o Second
13-27 weeks
weight gain: 04-0.5 kg per week, overweight 0.3 kg,
obese 0.2 kg per week
o Third
28-40 weeks
0.4-0.5 kg per week, overweight 0.3 kg per week,
obese 0.2kg
o overall 25-35
Presumptive signs- changes the woman experiences that make her
think she may be pregnant
o may be subjective or objective
o signs also may he a result of physiological factors other than
pregnancy (peristalsis, infections, stress)
Amenorrhea,
Fatigue
Due to initial fall in basal metabolic rate; BMR
gradually rises
n/v- first trimester
urinary frequencydue to pressing on bladder,
relieved in 4
th
mo
breast changes (darkened areolae, enlarged
montgomerys glands)colostrum present by 12 week
quickening (slight fluttering mvts of the fetus felt by
the woman usually between 16-20 weeks gestation),
uterine enlargement
changes in skin pigmentation
linea nigra- (estrogen/progesterone-
melanocyte-stimulating effect)
Striae (stretch marks) (abdomen, breasts,
buttocks, upper thighs)
Chloasma (mask of pregnancy) irregular brown
discolorations on forehead, cheeks and neck
Probable signs- changes that make the examiner suspect a woman is
pregnant (primarily related to physical changes of the uterus)
o can be caused by physiological factors other than pregnancy
(pelvic congestion, tumors)
abdominal enlargement related to changes in uterine
size, shape, position
Enlargement of the abdomen- ~4
th
mo
Hegars sign- softening and compressibility of lower
uterus
Chadwicks sign- deepened violet-bluish color of
cervis and vaginal mucosa
Goodells sign- softening of cervical tip
Hegar, Goodell, Chadwick evident by 6 weeks
McDonalds sign- flexibility of uterus against cervix
Ballottement- rebound of unengaged fetus; at 20
weeks
Braxton Hicks contractions- false contractons;
painless, irregular, and usually relieved by walking
Begins in 6
th
week
Not detectable until 2
nd
trimester
Women perceive contractions after 28 weeks
Positive pregnancy test
Uterine souffl (soft blowing sound at rate of maternal
pulse)
Fetal outline felt by examiner (20 weeks)
Positive signs- Signs that can be explained only by pregnancy
o Fetal heart sounds
o Visualization of fetus by ultrasound (4-5 weeks)
o Fetal mvt palpated an experienced examiner
Urine tests positive within 10-14 days after missed
period
FHB
Doppler 10-12
Fetoscope 16-20
Nageles rule- first day of womans last menstrual cycle, subtract three
months, and then add 7 days and one year
Measurement of fundal height in centimeters from symphysis pubis to
top of uterine fundus (between 18-32 weeks gestation)
o Approximates gestational age
Gravidity- number of pregnancies
o Nulligravida-woman who has never been pregnant
o Primigravida- woman in first pregnancy
o Multigravida-woman who has had two or more pregnancies
o Parity- number of pregnancies in which the fetus or fetuses
reach viability (20 weeks) regardless of whether the fetus is
born or alive
Nullipara- no pregnancy beyond the stage of viability
Primipara- has completed one pregnancy to satge of
viability
Multpara- has completed two or more pregnancies to
stage of viability
Para- birth after 20 weeks gestation regardless if dead
or alive
o GTPAL acronym
Gravidity
Term births(38 weeks or more)
Preterm births (viability up to 37 weeks)
Abortions/miscarriages
Living children