FIRST TRIMESTER OF PREGNANCY(FIRST 12 WEEKS)

:-FIRST TRIMESTER (FIRST 12 WEEKS)

:-SUBJECTIVE SYMPTOMS
: The following are the presumptive symptoms of early months of pregnancy: Amenorrhea during the reproductive period in an otherwise healthy individual having previous normal periods, is likely due to pregnancy unless proved otherwise. However, cyclic bleeding may occur upto 12 weeks of pregnancy, until the decidual space is obliterated by the fusion of decidua vera with decidua capsularis. Such bleeding is usually scanty, lasting for a shorter duration than her usual and roughly corresponds with the date of the expected period. This is termed as placental sign. This type of bleeding should not be confused with the commonly met pathological bleeding, i.e. threatened abortion. Pregnancy, however, may occur in women who are previously amenorrheic — during lactation and puberty. Morning sickness is inconsistently present in about 50% cases, more often in the first pregnancy than in the subsequent one. It usually appears soon following the missed period and rarely lasts beyond the first trimester. Its intensity varies from nausea on rising from the bed to loss of appetite or even vomiting. But it usually does not affect the health status of the mother. Frequency of micturition is quite troublesome symptom during 8–12th week of pregnancy. It is due to  (1) resting of the bulky uterus on the fundus of the bladder because of exaggerated anteverted position of the uterus, (2) congestion of the bladder mucosa and (3) change in maternal osmoregulation causing increased thirst and polyuria (p. 51). As the uterus straightens up after 12th week, the symptom disappears. Breast discomfort in the form of feeling of fullness and ‘pricking sensation’ is evident as early as 6–8th week specially in primigravidae. Fatigue is a frequent symptom which may occur early in pregnancy

OBJECTIVE SIGNS:



 the Breast changes are valuable only in primigravidae, as in multiparae, the breasts are enlarged and often contain milk for years. The breast changes are evident between 6–8 weeks. There is enlargement with vascular engorgement evidenced by the delicate veins visible under the skin .The nipple and the areola (primary) become more pigmented specially in dark women. Montgomery’s tubercles are prominent. Thick yellowish secretion (colostrum) can be expressed 
as early as 12th week

Per abdomen — Uterus remains a pelvic organ until 12th week, it may be just felt per abdomen as a suprapubic bulge. t Pelvic changes — The pelvic changes are diverse and appear at different periods. Collectively, these may be informative in arriving at a diagnosis of pregnancy. • Jacquemier’s or Chadwick’s sign: It is the dusky hue of the vestibule and anterior vaginal wall visible at about 8th week of pregnancy. The discoloration is due to local vascular congestion. • Vaginal sign: (a) Apart from the bluish discoloration of the anterior vaginal wall (b) The walls become softened and (c) Copious non-irritating mucoid discharge appears at 6th week (d) There is increased pulsation, felt through the lateral fornices at 8th week called Osiander’s sign. • Cervical signs: (a) Cervix becomes soft as early as 6th week (Goodell’s sign), a little earlier in multiparae. The pregnant cervix feels like the lips of the mouth, while in the non-pregnant state, like that of tip of the nose. (b) On speculum examination, the bluish discoloration of the cervix is visible. It is due to increased vascularity. t Uterine signs: (a) Size, shape and consistency — The uterus is enlarged to the size of hen’s egg at 6th week, size of a cricket ball at 8th week and size of a fetal head by 12th week. The pyriform shape of the non-pregnant uterus becomes globular by 12 weeks. There may be asymmetrical enlargement of the uterus if there is lateral implantation. This is called Piskacek’s sign where one half is more firm than the other half. As pregnancy advances, symmetry is restored. The pregnant uterus feels soft and elastic. (b) Hegar’s sign: It is present in two-thirds of cases. It can be demonstrated between 6–10 weeks, a little earlier in multiparae. This sign is based on the fact that : (1) upper part of the body of the uterus is enlarged by the growing fetus (2) lower part of the body is empty and extremely soft and (3) the cervix is comparatively firm. Because of variation in consistency, on bimanual examination (two fingers in the anterior fornix and the abdominal fingers behind the uterus), the abdominal and vaginal fingers seem to appose below the body of the uterus (Fig. 7.2). Examination must be gentle to avoid the risk of abortion. (c) Palmer’s sign: Regular and rhythmic uterine contraction can be elicited during bimanual examination as early as 4–8 weeks. Palmer in 1949, first described it and it is a valuable sign when elicited. To elicit the test, the uterus is cupped between the internal fingers and the external fingers for about 2–3 minutes. During contraction, the uterus becomes firm and well defined but during relaxation, becomes soft and ill defined. While the contraction phase lasts for about 30 seconds, with increasing duration of pregnancy ,the relaxation phase increases .After 10th week, the relaxation phase is so much increased that the test is difficult to perform

For more information click here