SYMPTOMS OF PREGNANCY.

Suppression of the Menses.—The cessation of the periods may be due to other causes, but it is usually the first indication of pregnancy. Conception may take place and menstruation yet continue. It usually occurs but once or twice, and then only where conception took place immediately before an expected period.

Morning Sickness.—Nausea and vomiting continued for any length of time is almost a certain sign of pregnancy. It may begin as soon as conception takes place and last for many months; sometimes it may occur toward the end of pregnancy, or occasionally not at all.

Salivation.—The excessive secretion of saliva often accompanies the morning sickness. The secretion is tenacious and difficult of expectoration. Heartburn, abnormal appetite, longing or loathing for particular articles of food, toothache and the like may be present.

Quickening.—The first feeling of fetal life felt by the mother is usually between the fourth and fifth months, but may be experienced occasionally as early as the third month, or be deferred until the sixth. Quickening occurs as soon as the uterus comes in contact with the abdominal wall. Improper elimination of the bowels, causing gastro-intestinal trouble, may produce movements not unlike this indication; therefore, this symptom is not reliable.

Enlargement of the Breasts.—The breasts grow larger toward the end of the second month. In some cases the enlargement is very marked, but in others there is scarcely any increase in size during the whole term of pregnancy.

Pigmentation.—Coloring of the skin takes place in different parts of the body. The face may show brownish spots. The skin darkens in the axilla and in the areola of the breasts. A dark line presents itself down the middle of the abdomen. The vagina takes on a violet tint, the cervix becomes purple, the various colors becoming more marked with the progress of pregnancy.

Changes in the Abdomen.—The abdomen grows larger gradually, and with it the gait and carriage of the woman change, to counterbalance the weight of the abdomen. It enlarges symmetrically unless the uterus is displaced by adhesions, or by a tumor in the uterus or external to it. The tearing of the under layer of the skin of the abdomen while distended produces streaks (stria), first pink and then white, which remain after the form resumes its natural shape; any other enlargement of the abdomen, especially when caused by a tumor, may produce the same result. The various conditions mistaken for pregnancy, due to changes in the abdomen, are fibroid in uterus; metritis; swelling of the tubes and ovaries, distended bladder, a pendulous belly; excessive fat; extra-uterine pregnancy; and inflammatory conditions, such as peritonitis. Pregnancy and any of the conditions named may coexist, and the former may be overlooked, while the latter is recognized.

Fetal Heartbeat.—The heart sounds are generally audible between the fourth and fifth months. The rate is from 120-140 a minute, being double that of the mother’s pulse. About midterm is heard the uterine souffle, a blowing sound, quite unlike the fetal heart, and its origin is the rushing of the blood through the enlarged and twisted arteries.

Ballottement.—In normal cases there is no pain on palpation. The uterine wall varies in consistence, being alternately soft and firm. The fetal parts may be felt through the abdominal wall in the late months.

Lightening.—In the last two weeks, especially in primiparæ, the child’s head sinks into the pelvis, and its body falls a little forward. The uterus sinks down and forward with the child. The waist-line lowers, the stomach region is flatter, the navel more prominent. The patient breathes easier, but does not walk as well.

Duration of Pregnancy.—Average time is 280 days; protracted, 314; a short term about 245 days. There is no positive period.

Prediction of the Date of Labor.—Count 9 calendar months from the beginning of the last menstruation and add 7 days. An error of 2 or 3 weeks, however, is possible. (See Table on page 178.)

Premonitory Symptoms of Labor.—(1) Lightening.—Dropping may be attended with slight pains similar to labor pains.

(2) False Pains.—These vary in nature and quality. They may be short and sharp, or long and continuous, or irregular. As a rule, they are marked by irregularity. They are mostly abdominal, rarely like true pains beginning in the sacral region and moving around to the region of the pubes. They may be caused by cramps in the abdominal wall, intestines, or in the distended bladder. They may be due to old inflammatory areas within the abdominal and pelvic cavities. They are frequent in cases in which there is marked bowel irregularity, and in conditions of over-fatigue. Some authors believe that they may be produced by irregular contractions of portions of the uterine wall. One important test is the condition of the uterine body during the pain. If there is no genuine contraction, the uterus will not become hard when pain is felt. This indication is not always reliable, however, since palpation may be unsatisfactory on account of the woman’s nervousness, her sensitiveness, or the thickness of the abdominal wall. If the cause be contractions of the uterus, partial hardening may be felt.

TABLE FOR CALCULATING THE PERIOD
OF UTERO-GESTATION.

January 1 2 3 4 567891011121314151617181920212223 24 25 26 27 28 29 30 31
October 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 Nov.
February 1 2 3 4 5678910111213141516171819202122232425262728
November 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 Dec.
March 1 2 3 4 5678910111213141516171819202122232425262728293031
December 6 7 8 910111213141516171819202122232425262728293031 1 2 3 4 5 Jan.
April 1 2 3 4 56789101112131415161718192021222324252627282930
January 6 7 8 910111213141516171819202122232425262728293031 1 2 3 4 Feb.
May 1 2 3 4 5678910111213141516171819202122232425262728293031
February 5 6 7 8 910111213141516171819202122232425262728 1 2 3 4 5 6 7 Mar.
June 1 2 3 4 56789101112131415161718192021222324252627282930
March 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 April.
July 1 2 3 4 5678910111213141516171819202122232425262728293031
April 7 8 9101112131415161718192021222324252627282930 1 2 3 4 5 6 7 May.
August 1 2 3 4 5678910111213141516171819202122232425262728293031
May 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 June.
September 1 2 3 4 56789101112131415161718192021222324252627282930
June 8 9 101112131415161718192021222324252627282930 1 2 3 4 5 6 7 July.
October 1 2 3 4 5678910111213141516171819202122232425262728293031
July 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 7 Aug.
November 1 2 3 4 56789101112131415161718192021222324252627282930
August 8 9 10111213141516171819202122232425262728293031 1 2 3 4 5 6 Sept.
December 1 2 3 4 5678910111213141516171819202122232425262728293031
September 7 8 9101112131415161718192021222324252627282930 1 2 3 4 5 6 7 Oct.

Explanation.—Find in top line the date of menstruation, the figure below will indicate the date when confinement may be expected, i.e., if date of menstruation is June 1st, confinement may be expected on March 8th, or one day earlier if leap year. (Dr. Ely.)

(3) True Pains.—The contractions of the uterus as they become stronger, in the great majority of cases, cause the woman pain. For this reason “true pains” is used synonymously with “uterine contractions.” With their appearance the woman becomes restless, likes to sit down, to bend forward and to press on the sacrum. “True pains” are felt in the sacral region, gradually moving around toward the pubes. They begin slowly, increase in intensity, and slowly pass away. The pains are involuntary, and the woman tries to complain or cry out. Differences in this largely depend upon the nervous temperament of the patient, though they are also related to variations in the physical factors. “True pains” must be distinguished from “false pains.”

(4) The Show.—Within twenty-four hours before labor really begins there is a discharge from the vagina of thick mucus, more or less stained with blood. This is called the “show,” and is the plug of mucus which fills the cervical canal during pregnancy. Sometimes the show is absent or appears after labor has been in progress for awhile. If there is much pure blood with the discharge it is unusual, and the physician should be notified.