Constipation is the Rule.—Neuralgias in different parts of the body, especially in the face and teeth, are common. Palpitation of the heart and difficulty in breathing may be experienced. A discharge from the vagina is almost always present, due to the increased circulation in the cervix and vagina.
The Foetal Heart-beat.—This is the one positive sign of pregnancy and it may be heard as early as the sixteenth to the twentieth week. It has been compared to the ticking of a watch under a pillow. It ranges in frequency from one hundred and ten to one hundred and fifty to a minute.
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Pelvic Signs.—As early as the first month of pregnancy a faint violet color of the anterior wall of the vagina just below the opening of the urethra may be distinguished. In the third month this color has become purplish and pronounced. This sign is present in eighty per cent of cases. There is also a more or less marked lividity of the vaginal portion of the cervix from the first month of pregnancy. Also there is softening of the cervix as early as the sixth week, and as pregnancy advances the whole of the cervix is softened.
Duration of Pregnancy.—This is for all practical purposes two hundred and eighty days.
How to Determine Date of Confinement.—The best rule is to count backward three months from the first day of the last menstrual period and add seven days to it. To be more accurate, in April and September only six days should be added; in December and January, five days; and in February, four days.
Position of the Womb.—At four months the top of the womb has risen above the pelvic brim bone in front; at five months, it is midway between the bone (pubic) and the navel; at six months, it is at the navel; at seven months, it is four fingers breadths above the navel; at eight months, it is midway between the navel and the bottom of the breast bone; at nine months, it is to the breast bone; from the middle to the end of the ninth month, the top of the womb sinks to about the position occupied at the eighth month.
Twins occur about once in ninety to one hundred and twenty, triplets once in one thousand eight hundred and seventy-five, and quadruplets once in three hundred and seventy-one thousand one hundred and twenty-six pregnancies. The causes are unknown. Twin conception is more common in women who have borne children, and more so in the elderly than in the young, first bearing women (primiparae).
Sex.—Children from the same ovum (egg) are always of the same sex. Of twins in general, more than one-third are males, less than one-third are females, and in the remaining one-third both sexes occur. The after-birth is always, at least at first, double.
Diagnosis.—In twin pregnancy the symptoms and disorders of pregnancy are apt to be exaggerated, and watery swelling above the pubic bone is almost always present in the latter months. The abdomen is larger and broader and there may be a depression dividing the abdominal wall in two spaces. The womb is much distended and the walls are thin.