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.)