02.03 Important Signs of Pregnancy

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Overview

  1. Signs of pregnancy are divided into 3 categories:
    1. Presumptive signs = “You might be pregnant”
    2. Probable signs = “It’s highly likely you’re pregnant”
    3. Positive signs = “Yea, you’re definitely pregnant”

Nursing Points

General

  1. Presumptive
    1. Amenorrhea, N/V, larger and fuller breasts, urinary frequency, pronounced nipples skin changes, fatigue, Quickening, changes in the color of vaginal mucosa, positive home pregnancy test
  2. Probable
    1. Ballottement, Chadwick’s sign, Goodell’s sign, Hegar’s sign, uterine enlargement, Braxton Hicks contractions, positive blood pregnancy test
  3. Positive
    1. Active fetal movement felt by practitioner, visual confirmation of fetus on ultrasound, fetal heartbeat heard on ultrasound (6-8 weeks) or by a doppler at around 12 weeks

Assessment

  1. Assess patient’s symptoms
    1. Quickening: Maternal feeling of the fetus move, the earliest usually around 16 weeks
    2. Ballottement: examiner inserts finger into the vagina, pushes on uterus and feels the return of the fetus to the finger
    3. Chadwick’s sign is a purple/blue/violet discoloration of the cervix, labia and vagina due to increased vascularity and  blood flow
    4. Hegar’s sign is a softening at the bottom of the uterus, usually around 4-6 weeks
    5. Goodell’s sign is at approximately 4 weeks gestation, the vaginal portion of the cervix gets softer due to increased vascularization

**Please note video has Hegar’s and Goodell’s signs reversed. Outline correct.

Therapeutic Management

  1. Patients should be started on prenatal vitamins as soon as they show probable signs of pregnancy if they haven’t already started
  2. Patients should be questioned about medications they currently take if confirmed pregnant
  3. If patients have severe nausea and vomiting they can be prescribed an anti nausea medication

Nursing Concepts

  1. Reproduction
  2. Human Development
  3. Hormone Regulation

Patient Education

  1. Help patients understand the difference between possible, probable, and positive signs of pregnancy.
  2. Offer education on the importance of a prenatal vitamin if they are pregnant.

Reference Links

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Video Transcript

In this lesson we are going to discuss the important signs of pregnancy and how to classify them.

There are 3 main classifications for our signs of pregnancy. They are either presumptive, probable or positive. For presumptive the signs are things such as amenorrhea, nausea/vomiting, larger and fuller breasts, urinary frequency, pronounced nipples skin changes, fatigue, Quickening, changes in the color of vaginal mucosa, positive home pregnancy test. Why would a home pregnancy test only be presumptive? That’s because it could be a false positive. Probable are things the mom observes or experiences. Probable are signs such things as ballottement, Chadwick’s sign, Goodell’s sign, Hegar’s sign, uterine enlargement, Braxton Hicks contractions, positive blood pregnancy test. Why would the blood test be probable? It could be ectopic of a hydatidiform molar pregnancy so not a true viable pregnancy. Probable signs are things the doctor observes or visualizes. Positive signs mean its definite. The patient is pregnant. So these are signs that would only be present if there is a fetus present. Signs would be active fetal movement felt by practitioner, visual confirmation of fetus on ultrasound, fetal heartbeat heard on ultrasound (6-8 weeks) or by a doppler at around 12 weeks.

For this we need to assess patient’s symptoms so we can classify first if she is pregnant and second if her symptoms are presumptive, probable, or positive. Let’s break down what some of these signs mean. Quickening is the maternal feeling of the fetus move. The earliest this is usually gelt is around 16 weeks. Ballottement is felt by the practitioner. It occurs when an examiner inserts finger into the vagina, pushes on uterus and feels the return of the fetus to the finger. Think of this as popping a water balloon up and feeling it come back down on your fingers. Chadwick’s sign is also observed by the practitioner and is purple/blue/violet discoloration of the cervix, labia and vagina due to increased vascularity and blood flow. Hegar’s is felt by the practitioner and is softening at the bottom of the uterus, usually around 4-6 weeks. Goodell’s sign is felt when the vaginal portion of the cervix gets softer due to the increased vascularization.

For our management there are a few things we need or can do. Patients need to be started on prenatal vitamins as soon as they show probable signs of pregnancy if they haven’t already started. Prenatal vitamins are important so that the patient gets extra folic acid which is needed to prevent neural tube defects. We also need to question about medications they currently take if confirmed pregnant. We need to make sure the medications are safe to be continued during pregnancy and will not harm the baby. If they are having symptoms of severe nausea and vomiting they can be prescribed an anti nausea medication to help with symptom management.

Reproduction, human development, and hormones are the nursing concepts. The patient has reproduced, she is developing a human, and hormones are a huge cause to all the pregnancy signs that she is experiencing.
The key points to remember and help pull it together are that presumptive signs mean“You might be pregnant” and they are usually felt by the patient. Probable signs mean “It’s highly likely you’re pregnant” and are observed by physician or provider. Last are positive signs which mean “Yea, you’re definitely pregnant”. These are signs that would only be present if the patient is pregnant.

Make sure you check out the resources attached to this lesson. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 5

A client who is 8 weeks pregnant is at the healthcare provider’s office for her first prenatal appointment. The client is complaining about how often she has to void. What is the best explanation by the nurse?

  • Question 2 of 5

A nurse is caring for a client who has recently found out she is pregnant with her first child. What is the priority nursing education topic for this client?

  • Question 3 of 5

Your client has noticed her nipples are enlarging and getting darker pigmented. What type of pregnancy symptom is this?

  • Question 4 of 5

The nurse is assisting a Provider in a pelvic exam. The Provider explains that the client’s cervix is bluish in color. What is this sign called?

  • Question 5 of 5

A client who had a positive pregnancy test comes for an appointment to find that she is not pregnant. She doesn’t understand how this is possible because it said “positive” on her test. What is the best explanation by the nurse?

Module 0 – OB Course Introduction

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