SYMPTOMS OF PREGNANCY WEEK BY WEEK IN WOMEN
Most times when a healthy married woman who has been menstruating properly misses her period she suspects that she is pregnant and in most cases of 90-98% she is correct. The use of modern advanced technological method (immunological pregnancy tests, use of ultrasonic devices etc) has outweighed/abolished the need of relying on inaccurate presumptive and probable signs of pregnancy.
In analyzing symptoms of pregnancy week by week in women the following presumptive signs are to be considered:
- Changes in the Breast: The breast is an accessory organ or generation thus changes in them occur very early as a result of the stimulus generated by the ovarian hormones-oestrogens and progesterone, even before a woman has missed a period she might still be conscious of a prickling, tingling sensation in her breasts. The oestrogen by function stimulates the growth of the glandular tissue and ducts, while the progestogens activates the secretory function of the breast. Most times as early as the sixth week, the breasts becomes enlarged and have a firm tense feeling (tender sometimes). The breast keeps on increasing during pregnancy with a weight of increase of about 450g, moreso the nipple gets more erectile with a darker color.
- Amenorrhea: it is invariably attached to pregnancy and the sudden termination of menstruation is most remarkable. In this case slight bleeding might take place during the ovum implantation and may be mistaken for menstruation thus there is need for the woman to check whether the last menstrual period was of normal length and amount. However change of environment, emotional disturbances and serious illness may also induce the suppression of menstruation. If contraceptive is used by a woman and is discontinued a period of amenorrhoea may kick off, thus it is pertinent that the woman should look for and record the date of breast changes, morning sickness and quickening. Most times at menopause due to increase in body weight and delay in menstrual period, women often erroneously presume they are pregnant
- Morning sickness: this occurs during the 4th to the 14th week in 50% of pregnant women , some other conditions could result to vomiting. Inasmuch as morning sickness is not considered a definite symptom, but in consonance with amenorrhea it suggests pregnancy.
- Quickening: this is a language/term which implies the movement of the fetus (developing child) in the utero when first noticed by the mother , it is usually felt between the 16th and 20th week.Inasmuch as the fetus is alive from the moment of conception but in the early months of conception the fetal limbs are not well developed and their movements are slow.It is only when the uterus has risen out of the pelvis and is in contact with the abdominal wall that any feeling of movement will be perceptible by the woman. There is no sense of touch in the uterus and the kicking must be transmitted to the abdominal wall before the woman is conscious of it. The symptom is non dependable because atimes non-pregnant women imagine they feel fetal movement.
- Bladder irritability: it occurs before the 12th week , and usually consists of frequency of micturition without pain or burning
- Skin Changes:this includes pigmentation , symptoms such as chloasma, linea nigra, darkening of the primary areola and formation of the secondary areola of the breasts. These are useful signs but they are not indisputable signs of pregnancy. The presence of striae on the abdomen, thighs and breasts is an equally indefinite sign.
Probable signs of Pregnancy
In analyzing symptoms of pregnancy week by week in women the following probable signs are to be considered.The majority of the signs below are diagnosed by the doctor majorly through vaginal examination, the midwife must first ensure that the patient's bladder has first been emptied.
- Hegar's Sign: This sign occurs between the 6th to 12th week, it is one of the early signs its not often employed unless facilities for pregnancy tests are not available. Here two fingers are inserted into the anterior fornix of the vagina, and the other hand is placed abdominal behind the uterus. The fingers of both hands likely meet because of the tenderness(softness) of the isthmus which is marked at this period. Carefulness is pertinent to avoid rough handling of the uterus (womb).
- Jacquemier's sign: This sign occurs as from the 8th week onwards, this is the violet blue discoloration of the vaginal mucous membrane and it occurs due to pelvic congestion. It may also be likely present in cases of retroversion and pelvic cellulitis.
- Osiander's sign: This sign also occurs from the 8th week onwards, here the size of the uterus (womb) enlarges , the consistency becomes soft, and the shape becomes globular rather than pear shape.
- Softening of the cervix: This occurs as from the 10th week onwards: The cervix (the narrow outer end of the uterus) feels like the tip of the nose in non-pregnant uterus but here the consistency of the cervix is comparable with that of the lips .
- The uterine souffle: This occurs from the 16th week onwards: it is a soft blowing sound, heard on auscultation and synchronous with the mother's pulse, the uterine souffle is also heard when the fibroid tumours are found present and during the puerperium(the period between childbirth and the return of the uterus to its normal size).
- Abdominal enlargement: This also occurs from the 16th week onwards, This is the only condition that makes the uterus enlarge so rapidly and so progressively. However abdominal enlargement may also be as a result of fat accumulation, gaseous distension of the bowel(the long tube in the body that helps digest food and carries solid waste out of the body) , a full bladder, tumors or ascites.
- Braxton Hick's contractions: This occurs from the 20th week onwards; these are the contractions being felt on the abdominal palpation, it occurs in about 15 minutes in pregnancy and increases its intensity after the 35th week. These contractions enhance/facilitates the circulation of blood in the placental region and it also plays a role in the development of the lower uterine segment.
- Internal ballottement: This sign occurs occurs from the 16th to 28th week of pregnancy, it is most useful in cases of obesity during mid-term and is performed with the patient in the semi-recumbent (semi-lying down) position. Here two fingers are inserted inside the vagina, and the uterus (womb) is given a sharp tap just above the cervix, this causes the fetus to float upwards in the amniotic fluid. The left hand, which is placed abdominally on the fundus uteri, detects the gentle impact of the fetus. The fetus sinks back again and is felt by the fingers in the vagina; this rebound is called Ballottment.
NB: It is pertinent to know that none of these signs are positive, as there are fallacies, mostly gynaecological in origin, that prevent them from being quite conclusive. The probable signs of pregnancy are more reliable than the presumptive signs.
IMMUNOLOGICAL PREGNANCY TESTS (Hobson)
The most reliable immunological tests are those which are dependent upon the presence of the hormone - chorionic gonadotropin in the urine. This hormone gets released/excreted immediately after the fertilised egg has been implanted and it continues to be present in the urine in various amounts throughout pregnancy and also in the puerperium (the period between childbirth and the return of the uterus to its normal size). Basically Immunological tests for pregnancy are of two types:
(a) HAEMAGGLUTINATION INHIBITION TESTS such as earlier tests -Pregnosticon (Organon Ltd) and Prepuerin (Burroughs Wellcome & Co. and
(b) LATEX PARTICLE TESTS like Gravindex (Ortho Pharmaceutical Ltd), Planotest (Organon Ltd.) and Prepurex (Burroughs Wellcome & Co.). These tests are available in kits containing all the necessary reagents; the urine to be tested are mixed together with the reagents in a tube or ampoule.
In inhibition of haemagglutination test, A positive reaction, appears as a brown ring or button at the bottom of the ampoule or tube. However in a negative reaction, haemaglutination appears as a uniformly yellow-brown precipitate at the bottom of the tube.
In the Latex particle inhibition test, the reagent and urine are mixed together in a glass slide. In a positive result there is no agglutination (clumping into a mass) of particles but in a case of negative result there is agglutination and it occurs within 2 minuites of the reagents being mixed together.
Practically the Haemagglutination tests Pregnosticon and Prepuerin are notable for its accuracy and can be expected to give the correct answer in about 99% cases. The slide tests ( Latex particle tests) which is considered less sensitive are less accurate and will give the right answer in aprroximately 96-98% cases. It is also important to note that reliable results are achieved if the tests are done on urines collected 14 days after the missed but expected period. Moreso a Positive Pregnancy Test is not synonymous with the presence of a viable fetus.
In summary Immunological Tests just like Biological tests measures the presence and abundance of the hormone "chorionic gonadotropin" and will be considered positive when urine samples from women who are pregnant, who have a hydatidiform mole, invasive mole or choriocarcinoma( a malignant tumor typically developing in the uterus from the trophoblast) are tested.
NB: For these tests an early morning specimen if the urine of about 15 ml is required (labeled accurately, kept cool and sent to the laboratory as soon as possible).
OTHER POSITIVE SIGNS OF PREGNANCY
In analyzing symptoms of pregnancy week by week in women the following below are confirmed positive signs of pregnancy
- Ultrasonic evidence: This is available or noticeable as early as 6 weeks amenorrhoea (abnormal absence or suppression of menses): the gestation sac being seen on the oscilloscope screen or recorded by a polaroid camera as an ultrasonogram. The Sonicaid and the Doptone ultrasonic detectors pick up the fetal heart beat at 14 weeks and have done so at 10 weeks.
- Hearing the Fetal heart: This is one of the most convincing sign of pregnancy, with acute hearing it can be detected as early as the 20th week (usually about the 24th week ). When the abdominal wall is thick, when the amount of amniotic fluid is excessive, or the examining room is noisy, the heart sounds may be inaudible or not heard; but inability to hear the fetal heart does not particularly exclude pregnancy or denote fetal death although it may arouse suspicion.
- Fetal parts: It can be felt at about the 22nd week, alternatively fibroids may be mistaken for fetal parts.
- Fetal movement: It is detected by the examiner in about the 22nd week, It should not be confused with the movement felt by the mother (quickening)
- Radiological demonstration of the fetal skeleton is possible/can be made at 16th week of pregnancy, on the other hand since other diagnostic methods are available thus X-rays are not used at this early stage because of the radiation hazards.