Clinical signs of pregnancy. Questionable signs of pregnancy

All women expecting pregnancy engage in scrupulous soul-searching in search of symptoms of its onset. Some people want this so much that they begin to turn on all the absurd fantasy buttons and monitor a number of “pregnant” signs in everything, for example: “stuffy nose - I’m pregnant”, “I want a cucumber - am I really pregnant”, “don’t want a cucumber - I’m probably pregnant." To help paranoid mothers, there are reliable signs of pregnancy, consisting of three categories:

1. possible (indicate the likelihood of successful conception);
2. probable (indicating a high degree of probable conception);
3. accurate (are indisputable evidence of probable conception).

1. Lack of menstruation (delay)
   This is the first sign by which women begin to suspect pregnancy. But a delay should be taken as a sign only with a regular menstrual cycle. Otherwise, late periods may be caused by:
   • stress or depression;
   • a sharp change in the usual life schedule;
   • increased physical activity;
   • medicines;
   • increased body weight or lack thereof;
   • menopause or premenopausal period.
2. Changed nature of menstruation
   Any deviation from the usual and normally current menstrual cycle may be a sign of pregnancy: too long or short a monthly cycle, heavy or scanty menstrual discharge. However, in addition to pregnancy, a malfunction in the cycle may be the result of any disease of the reproductive system and a reason to contact gynecologist.
3. Painful sensations
   In the first days after pregnancy, many women experience pain in the lower abdomen that is similar in nature and intensity to menstrual pain.
4. Nausea and vomiting
   This sign is a faithful companion for most pregnant women, which can be observed both at the beginning of pregnancy and throughout its entire duration. Most often, nausea and vomiting appear in the sixth week of pregnancy, but still 5% of women begin to feel their appearance from the first days. In addition to pregnancy, these symptoms may indicate diseases of the gastrointestinal tract (GIT). But there is one difference - gastrointestinal disease is not limited to vomiting and nausea, but is accompanied by other unpleasant symptoms.
5. Change in libido
   During pregnancy, the female body “cranks out” a large number of different processes that entail changes in behavior, sensations and perceptions. The situation is the same with sexual desire. All ongoing processes contribute to the disappearance or activation of a woman’s libidinal sphere. To physical changes may include increased sensitivity of the breasts, touching which can cause both pleasant and unpleasant sensations, gagging, increased blood flow to the organs of the reproductive system, etc. Towards psychological changes include the influence of the “frenzied” hormonal levels on the nervous system.
6. Breast tenderness and tenderness
   During pregnancy, the breast undergoes a number of preparatory processes for feeding the baby and is accompanied by a set of changes:
   • increased sensitivity and pain;
   • the color of the nipple halo changes;
   • there is swelling of the nipple and the isola;
   • breasts increase in size;
   • When you press on the nipple, colostrum is released.
7. Breast augmentation
   During pregnancy, mammary gland enlargement occurs evenly in one and the other breast. If only one breast is enlarged, this may be a sign of a disease.
8. Frequent urge to urinate
   This symptom accompanies a woman throughout the entire period of pregnancy and appears as a result of an increase in the size of the uterus. As it increases, it puts pressure on the bladder, the space for which becomes less and less every day, and the urge to urinate more and more often. This symptom can also be observed in various diseases of the urinary and endocrine system (urethritis, cystitis, diabetes mellitus, etc.) .P.). But besides the urge to urinate, the disease also has a number of other signs (temperature, pain, burning).
9. 
   The hormonal chaos occurring in the body of a pregnant woman often throws her mood from one extreme to another. Tearfulness can give way to sudden joy, and vice versa. This is usually temporary, but some women may experience it throughout their pregnancy.
10. Change in taste preferences
    There is an opinion among people that if you have a craving for something salty, then it means you are pregnant. In fact, a pregnant woman’s taste preferences can affect completely different groups of products, ranging from edible to unsuitable substances. Some limit themselves to ice cream with herring, while other pregnant gourmets fill their bellies with starch, chalk, earth, raw cape, etc. It is believed that taste perversion appears as a result of a lack of one or another microelement. A lack of iron, for example, in addition to cravings for certain foods, can be accompanied by brittle hair, nails, general weakness and fatigue.
11. Increased fatigue
    Pregnancy is a serious burden on a woman’s body. Every day he has to cope with many processes that require a certain amount of energy and effort. It is for this reason that during the difficult period of bearing a child it is common for a woman to experience increased fatigue, drowsiness and fatigue. This sign is not decisive, as it can occur with various diseases or be a consequence of changes in the usual lifestyle.
12. Formation of tubercles of Manngomery
    The place where tubercles form during pregnancy is the areola on the chest. It is on this that small pimples are concentrated, reminiscent of “goose bumps” and do not pose any threat to a woman’s health.
13. Skin changes
    All internal changes in the body tend to manifest themselves on the skin. Pregnancy has its own set of skin changes:
    • chloasma– focal hyperpigmentation of the facial skin, resulting from increased secretion of melanotropin. Location: forehead, cheeks, nose. After the baby is born, the pigmentation gradually disappears.
    • longitudinal line on the abdomen, which starts from the pubis and stretches upward towards the chest, and becomes noticeable from the third month of pregnancy.
    • skin rashes, as a sign of pregnancy, are not typical for every woman. During this period, some people have smooth and almost perfect skin, while others suffer from acne, which appears due to the active work of the sebaceous glands.
    • spider veins(“marble skin”, spider veins) usually form on the legs, chest, arms, cheeks and neck as a result of the active production of female sex hormones.
14. Stretch marks
    As a result of rupture of the collagen fibers of the skin, light, uneven stripes may appear, which are stretch marks.
    Stretch marks are the result of the destruction of connective tissue and form in most pregnant women. During pregnancy and after childbirth, they are usually observed in the vast majority of women (60-90%) and are located on the abdomen, chest, hips and arms. Their number directly depends on genetic predisposition, the rate of weight gain and the specifics of nutrition.
15. Increased size of the uterus
    As the fetus grows, there is a gradual increase in the volume of the uterus and, accordingly, the size of the abdomen. But, unfortunately, pregnancy is not the only reason for an increase, since neoplasms in the uterus are also characterized by a noticeable change in its size. There are also diseases in which only the volume of the abdomen increases, and the uterus remains the same (ascites, hyperplasia).
16. Colostrum from the breast
    Colostrum is the baby's first and healthiest food. Usually the first drops appear at the end of pregnancy, but in some women this process begins at an earlier stage.

All of the above reliable signs of pregnancy have been confirmed by time and experience of all successful mothers. However, 25 signs of pregnancy are not supplemented by one more thing - a woman’s premonition. Sometimes it alone can replace all twenty-five.

Diagnosis of pregnancy is of particular interest not only within obstetric practice - knowledge of its principles will not hurt people who are quite far from medicine. The fact is that quite a lot of time passes from the moment of conception to the appearance of obvious signs of its result. Therefore, various indirect manifestations have long been identified, which are less or more likely to indicate the development of pregnancy.

Now, due to the widespread use of modern technologies, the significance of such symptoms is gradually being lost. But conceiving a child is not always a planned process - a woman may not expect pregnancy to develop at all. Despite the information content of a blood test for hCG, its implementation is most justified only no earlier than the 10th week. How then can one suspect that an embryo is already growing and developing in the uterine cavity?

For such purposes, since the last century, there have been various signs indicating the development of pregnancy. For ease of use, they were divided into several groups according to their information content. Individually, they are not of particular value (except for probable signs), so their assessment is usually carried out comprehensively. Moreover, each group of symptoms acquires its significance during certain periods of pregnancy.

Questionable signs

These manifestations, although they carry the least value for the researcher, arise the earliest. The maximum limit for their appearance is no more than 4 weeks from the moment of conception. The development of such signs is characterized by a number of common points:

1. The greatest severity of symptoms (especially subjective) is typical for women for whom this is the first pregnancy.
2. The intensity of the manifestations also depends on the age of the pregnant woman - the younger the girl, the more pronounced they will be.
3. Characteristic is a gradual and sequential development of symptoms - only extremely rarely do they occur simultaneously. Moreover, a woman may not necessarily experience all the phenomena that will be listed below.
4. Subjective symptoms always appear first, and only after them do objective symptoms appear. Moreover, the former are characterized by relative instability - they can repeatedly strengthen and weaken, appear and disappear again.
5. Objective manifestations after development usually persist throughout the entire period of gestation, and gradually disappear only in the postpartum period.

Presumable signs of pregnancy serve more so that the woman herself can suspect this condition in herself before going to see a doctor.

Subjective

The essence of these phenomena is a change in a woman’s well-being, as well as some physiological functions. But the problem is that their severity and character in individual cases varies greatly. Therefore, subjective doubtful signs of pregnancy should be listed only in general terms:

• First of all, this is the lability (instability) of the nervous system. It manifests itself as severe drowsiness or insomnia, a feeling of malaise and weakness, and frequent mood swings.
• In connection with these same processes, intolerance to certain odors is noted - especially colognes and perfumes, tobacco smoke. They cause a woman to experience attacks of dizziness and nausea.
• There is a change in food preferences and appetite - an irresistible craving for certain dishes and products appears, along with an aversion to others.
• Mostly in the morning hours, a transient feeling of nausea occurs, which may even be accompanied by a single act of vomiting.
• Increased urination, not accompanied by pathological symptoms, is also a dubious sign of pregnancy, especially in combination with other phenomena.
• A transient feeling of tension in the mammary glands, as well as their increased sensitivity, appears a little later than other manifestations. Although often the onset of pregnancy is warned only by its occurrence.

Most pregnant women associate such manifestations with the development of early toxicosis, although this approach is incorrect. Unlike symptoms that have a pathological origin, they are not persistent and do not disturb the general condition of the woman.

Objective

This group of signs includes only those phenomena that the woman herself or the doctor can see during the examination. Unlike subjective symptoms, their occurrence is characteristic not only of early pregnancy. Therefore, their comprehensive assessment can be carried out in any trimester:

• The first to be noted is the appearance of foci of increased pigmentation, caused by progressive changes in hormonal levels. The most characteristic localizations are the areola and the white (midline) line of the abdomen. Less commonly, such areas appear on the skin of the face.
• Not earlier than the second trimester, stretch marks appear - red or pink “pregnancy stripes” on the skin of the abdomen, thighs and mammary glands. Their occurrence is due to the complex effect of progesterone on the female body.
• For later periods, the presumptive sign is an objective enlargement of the abdomen. Quite often, women turn to a doctor only after “suddenly” discovering this phenomenon.

Questionable symptoms are only the first stage in diagnosing pregnancy, on the basis of which one can only suspect this condition. But at the same time, their assessment is the simplest and most accessible in the early stages.

Possible signs

From this stage, a professional assessment of the specific manifestations present or absent in the woman is carried out. Therefore, all detected symptoms are purely objective - their detection and confirmation is possible only with the participation of a doctor. Almost all of them relate to the transformation of the genital organs during pregnancy:

• The most characteristic, but at the same time the most nonspecific manifestation is the absence of regular menstruation - delay (physiological amenorrhea). In this case, the main condition for its assessment is the previously existing normal menstrual cycle in a woman of reproductive age.
• When examined in the speculum, cyanosis is noted - a bluish coloration - of the vaginal mucosa and the outer surface of the cervix. This symptom can only be assessed by examination by a doctor.
• During a gynecological two-handed examination, an increase in the size of the uterus is determined, as well as changes in its other parameters. To characterize the detected phenomena in obstetric practice, specific clinical symptoms are used.
• In women who are conceiving for the first time, probable signs of pregnancy also include the appearance of drops of colostrum on the nipples when pressure is applied to them.

A positive result from rapid tests used for confirmation at home also belongs to the group of probable signs. Elevated hCG values ​​measured in the blood have similar value.

Clinical symptoms

To standardize the data obtained, some characteristic features were named after the scientists and doctors who first discovered and described them. Most of the symptoms listed below existed before, but now they serve precisely as possible manifestations of pregnancy:

1. A general criterion that is not sufficiently specific is uterine enlargement. It can be detected during a simple examination no earlier than the 12th week, when the bottom of the organ reaches the level of the upper edge of the symphysis pubis, or is located slightly higher.
2. The Horwitz-Hegar sign is determined during a two-manual gynecological examination. It characterizes the softening of the uterus (mainly in the lower segment), which allows the doctor to make indirect contact with the fingers through the soft tissue.
3. Chadwick's sign is used to reflect the bluish color of the vaginal mucosa found during a simple speculum examination.
4. Piskacek's sign describes a change in the symmetry of the uterus during the first weeks after conception, which is detected during examination. The change in the shape of the organ is due to the attachment and growth of the embryo in the area of ​​one of the corners. Over time, this phenomenon disappears.
5. The Gauss and Gubarev sign also characterizes a decrease in the elasticity of the uterus - upon examination, increased mobility of the cervix is ​​determined, which does not affect the body of the organ.
6. A similar mechanism explains the appearance of Snegirev’s symptom, indicating variability in soft consistency. Against the background of mechanical irritation (pressure), a noticeable contraction and thickening of the uterus occurs, which soon disappears on its own.
7. Genter's symptom is found quite rarely. It is confirmed when a thickening in the form of a dense ridge is detected on the anterior surface of the uterus.

Most of the listed signs are available for assessment in the period from 5 to 8 weeks, which allows us to say with sufficient confidence about a positive outcome of conception even in the first trimester.

Reliable signs

The nonspecific nature of the previously listed symptoms is due to the fact that in some cases they accompany the development of certain endocrine and gynecological diseases. Therefore, only methods that confirm the development and growth of a living fetus inside the uterus can reliably and accurately establish the fact of pregnancy. For this purpose, two groups of methods are currently used:

• Clinical examination was previously the only way to detect reliable signs of pregnancy. It includes external obstetric examination techniques - Leopold's maneuvers and listening to the fetal heartbeat. But their assessment is possible only in the second trimester - from about 18 weeks.
• Now instrumental diagnostics are coming to the fore, providing direct visualization of the process occurring in the uterine cavity. Ultrasound examination (ultrasound) allows you to reliably confirm pregnancy already in the first trimester.

Due to the availability and effectiveness of instrumental methods, now the assessment of expected and probable manifestations in a pregnant woman is of secondary importance.

Clinical

A comprehensive assessment of reliable signs, carried out according to the examination of a woman, is possible only in the second trimester. Only closer to the 20th week is it possible to say with certainty that a child is growing and developing inside the uterus. And for this you need to get positive results of an external obstetric examination:

• Using Leopold's techniques, the location of the main (head, pelvis) and small - limbs - palpable parts of the fetal body is determined. It is the detection of these signs, as well as the registration of movements - kicks - of the child during palpation that reliably indicates the development of pregnancy.
• Another diagnostic element is auscultation, which allows you to hear the baby’s heartbeat using a special instrument (obstetric stethoscope). Normally, it also allows you to hear the small heartbeat for the first time between 18 and 21 weeks of pregnancy.

Previously, this stage of the study was confirmatory for the first two described earlier. Therefore, it was possible to confirm the fact of conception with accuracy only in the second trimester.

Instrumental

Currently, the duration of pregnancy diagnostics is reduced as much as possible - all measures taken take no more than two stages. If conception is planned, then its result can be confirmed using a reliable method already in the first trimester. Moreover, the method used for this purpose is absolutely safe for both the mother’s body and the fetus.

Ultrasound examination has completely taken over the functions that external obstetric examination had. Therefore, it allows you to estimate the same parameters, only with greater accuracy of information transfer:

1. An ultrasound examination performed using a transabdominal sensor allows you to diagnose pregnancy starting at 4 weeks. And if the study is carried out transvaginally - through the posterior vaginal fornix - then conception can be confirmed even earlier.
2. During the first trimester, an undoubted manifestation of pregnancy is the detection of a developing fertilized egg in the organ cavity, as well as visualization of its individual components. These include the embryo itself and its surrounding structures.
3. If the assessment is carried out closer to the second trimester, then the study already visualizes a living and formed fetus with the membranes surrounding it.
4. An important criterion for vital activity is the registration of the heartbeat of the embryo - with the help of ultrasound, this became possible already from the 5th week of pregnancy. And motor activity can be assessed already at the end of 2 months from the moment of conception.

The high efficiency and safety of ultrasound examination has made it the leading method used in obstetric practice. And its informativeness and versatility made it possible to use it not only for diagnosing pregnancy, but also to exclude various disorders and diseases in the fetus.

choose a topic... 1. Birth canal. The fetus as an object of labor 2. Biomechanism of childbirth 3. Clinical examination of pregnant women and their examination in the gastrointestinal tract 4. Clinical course of labor 5. Toxicosis 6. Normal postpartum period 7. Bleeding during pregnancy 8. Bleeding in the third and early postpartum periods 9. Obstetric trauma 10 Obstetric operations 11. Pregnancy and childbirth with S/S diseases 12. Incorrect positions and presentations of the fetus 13. Anomalies of labor 14. Narrow pelvis 15. Pathology of newborns 16. Postpartum purulent-septic diseases 17. Induced abortion 18. Post-term pregnancy 19. Kidney diseases and pregnancy 20. Miscarriage 21. Amniotic fluid embolism 22. Diabetes mellitus and pregnancy

1. A pregnant woman must register with the antenatal clinic before her pregnancy.

• 1) 5 weeks
• 2) 12 weeks
• 3) 14 weeks
• 4) 16 weeks
• 5) 2O weeks

2. Physiological pregnancy continues

• 1) 24O days
• 2) 28O days
• 3) 32O days
• 4) 22O days
• 5) 3OO days

3. The perinatal period continues

• 1) from 12 weeks of pregnancy until the birth of the fetus
• 2) from 2O weeks of pregnancy to 7 days after birth inclusive
• 3) from 28 weeks of pregnancy to the 56th day after birth inclusive
• 4) from 28 weeks of pregnancy to 7 days after birth inclusive
• 5) from 32 weeks of pregnancy to 7 days after birth inclusive

4. A pregnant woman should attend an antenatal clinic in the first half of pregnancy

• 1) once a week
• 2) 1 time in 1O days
• 3) once every 2 weeks
• 4) once a month
• 5) 2 times per trimester

5. In the second half of pregnancy, a pregnant woman should attend an antenatal clinic

• 1) once a week
• 2) 1 time in 1O days
• 3) once every 2 weeks
• 4) once a month
• 5) 2 times per trimester

6. When observed in a antenatal clinic, every pregnant woman must be examined

• 1) therapist, surgeon, dentist, ENT specialist
• 2) a therapist and a dentist, if indicated - other specialists
• 3) therapist, hematologist, dentist, venereologist
• 4) a dentist, an ENT specialist, and, if indicated, other specialists
• 5) therapist, infectious disease specialist, dentist, venereologist

7. A healthy pregnant woman should be examined by a therapist

• 1) 2 times per pregnancy
• 2) 2 times a month
• 3) 2 times per trimester
• 4) once every 2 months
• 5) 3 times a month

8. Miscarriage is called termination of pregnancy.

• 1) up to 12 weeks
• 2) up to 2O weeks
• 3) up to 25 weeks
• 4) up to 28 weeks
• 5) up to 3O weeks

9. A woman receives prenatal leave during pregnancy

• 1) 3O weeks
• 2) 32 weeks
• 3) 35 weeks
• 4) 28 weeks
• 5) 34 weeks

10. A clinical blood test for pregnant women is carried out in the antenatal clinic

• 1) 2 times a month
• 2) once a month
• 3) 3 times during pregnancy
• 4) 2 times per trimester
• 5) once every 2 months

11. During observation in the antenatal clinic, a general urine test is carried out for pregnant women

• 1) 2 times per trimester
• 2) once a month
• 3) 2 times a month
• 4) once a week
• 5) for every doctor visit

12. The Wasserman reaction is carried out during pregnancy

• 1) 1 time
• 2) every 2 months
• 3) once a month
• 4) 3 times
• 5) 2 times per trimester

13. Examination of smears for Neisser's gonococci in pregnant women is carried out

• 1) 1 time per pregnancy
• 2) once a month
• 3) every 2 months
• 4) 3 times during pregnancy
• 5) 2 times per trimester

14. Ultrasound examination for the purpose of prenatal diagnosis should be carried out

• 1) once in the first trimester of pregnancy
• 2) once in the second trimester of pregnancy
• 3) three times in the I, II and III trimesters of pregnancy
• 4) in the first and second trimesters of pregnancy
• 5) according to strict indications

15. Pregnant women are given immunoprophylaxis

• 1) tetanus
• 2) measles
• 3) diphtheria
• 4) polio
• 5) staphylococcal infection

16. The main task of psychoprophylactic preparation of a pregnant woman for childbirth is

• 1) explanation of the influence of environmental factors on the course of pregnancy and fetal development
• 2) familiarization with the basics of hygiene regime and nutrition of pregnant women
• 3) explanation of the physiological essence of childbirth and the course of the postpartum period
• 4) elimination of the psychogenic component of labor pain
• 5) familiarization of pregnant women with the structure and functions of the genital organs, the clinical course of childbirth

17. Psychoprophylactic preparation of pregnant women for childbirth begins

• 1) from 12 weeks
• 2) from 15-16 weeks
• 3) from 2O-22 weeks
• 4) from 26-28 weeks
• 5) from 32-35 weeks

18. First- and multi-pregnant women begin to feel fetal movements, respectively.

• 1) from 16 and 14 weeks
• 2) from 18 and 16 weeks
• 3) with 2O and 18 weeks
• 4) from 22 and 2O weeks
• 5) from 24 and 22 weeks

19. Vaginal examination during clinical monitoring of a pregnant woman in the second trimester

• 1) should be carried out if placenta previa is suspected
• 2) carried out to clarify the nature of the presenting part
• 3) must be carried out at each appearance
• 4) carried out once per trimester
• 5) carried out only if indicated

20. To clarify the 30-week pregnancy period, you can use

• 1) X-ray method
• 2) Ultrasound
• 3) ECG and FCG of the fetus
• 4) amnioscopy
• 5) cytological method

21. Piskacek’s sign belongs to the group

22. The Horwitz-Hegar sign belongs to the group

• 1) possible signs of pregnancy
• 2) doubtful signs of pregnancy
• 3) probable signs of pregnancy
• 4) reliable signs of pregnancy

23. Biological methods for diagnosing pregnancy belong to the group

• 4) reliable signs of pregnancy

24. The appearance of colostrum belongs to the group

• 1) probable signs of pregnancy
• 2) suspected signs of pregnancy
• 3) doubtful signs of pregnancy
• 4) reliable signs of pregnancy

25. Among the signs of early pregnancy, cessation of menstruation belongs to the group

• 1) probable signs of pregnancy
• 2) suspected signs of pregnancy
• 3) doubtful signs of pregnancy
• 4) reliable signs of pregnancy

26. Cyanosis of the mucous membrane of the vagina and cervix belongs to the group

• 1) probable signs of pregnancy
• 2) suspected signs of pregnancy
• 3) doubtful signs of pregnancy
• 4) reliable signs of pregnancy

27. Questionable signs of pregnancy include

• 1) palpation of parts of the fetus, listening to fetal heart sounds
• 2) ultrasound and x-ray registration of fetal images, registration of fetal cardiac activity
• 3) cessation of menstruation, cyanosis of the vaginal mucosa, change in the size, shape and consistency of the uterus
• 4) changes in appetite, olfactory sensations, morning sickness, mood instability
• 5) positive biological and immunological reactions to pregnancy

28. A likely sign of pregnancy is

• 1) registration of fetal movements
• 2) positive immunological reaction to pregnancy
• 3) change in appetite
• 4) registration of fetal heart sounds
• 5) ultrasound recording of the fetal image

29. A reliable sign of pregnancy is

• 1) change in the shape, size and consistency of the uterus
• 2) nausea, vomiting in the morning
• 3) cyanosis of the vaginal mucosa
• 4) positive biological reaction
• 5) palpation of parts of the fetus

30. The appearance of Horwitz-Geghar and Gubarev-Gaus signs during early pregnancy is due to

• 1) asymmetry of the uterus
• 2) contraction of the uterus during palpation
• 3) enlarged uterus
• 4) softening of the uterine body
• 5) softening of the isthmus of the uterus

31. Snegirev’s sign for diagnosing early pregnancy is

• 1) in the asymmetry of the uterus
• 2) in softening the isthmus
• 3) in the inflection of the uterus
• 4) in contraction of the uterus during palpation

32. Piskacek’s sign for diagnosing early pregnancy is

• 1) in the asymmetry of the uterus
• 2) in an increased bend of the uterus anteriorly
• 3) in softening the isthmus of the uterus
• 4) in contraction of the uterus during palpation
• 5) in easy displacement of the cervix

33. Biological methods for diagnosing pregnancy include

• 1) reaction of Simola and Nervenen
• 2) reaction of Florence and Feulgen
• 3) Aschheim-Tsondek, Galli-Mainini, Friedman reaction
• 4) reactions with the “gravidodiagnosticum” and “gravimun” kits
• 5) Coombs reaction

34. The immunological method for diagnosing early pregnancy is based on the reaction between

• 1) progesterone in the blood and antiserum
• 2) human chorionic gonadotropin in urine and antiserum
• 3) pregnanediol and antiserum
• 4) estrogens and antiserum
• 5) placental lactogen and antiserum

35. Diagnostic signs associated with changes in the shape and consistency of the pregnant uterus include signs

• 1) Klein, Rossier, Hohenbichler
• 2) Rogovin and Zanchenko-Schatz-Unterberger
• 3) Piskachek, Snegirev, Gubarev-Gaus, Horvits-Geghar, Genter
• 4) Alfeld, Schroeder and Dovzhenko
• 5) Mikulic, Strassmann and Chukalov-Kustner

36. Diagnosis of pregnancy using the Aschheim-Tsondeka reaction is based on the appearance

• 1) growth of follicles in rabbits under the influence of human chorionic gonadotropin in the urine of pregnant women
• 2) luteinization of follicles in rabbits under the influence of estrogens in the urine of pregnant women
• 3) luteinization of follicles in infantile female mice under the influence of pregnanediol
• 4) sperm in the cloaca of male frogs under the influence of human chorionic gonadotropin in the urine of pregnant women
• 5) hemorrhages into the cavity of the follicles and their luteinization in infantile female mice under the influence of human chorionic gonadotropin in the urine of pregnant women

37. Diagnosis of pregnancy using the Galli-Mainini reaction is based on the influence

• 1) progesterone in urine on luteinization of follicles in female lake frogs
• 2) pregnanediol in urine on sperm production in male lake frogs
• 3) human chorionic gonadotropin in urine on sperm production in male lake frogs
• 4) placental lactogen in urine on sperm production in male lake frogs
• 5) estrogen in urine on sperm production in male lake frogs

38. The Friedman reaction for diagnosing pregnancy is based on the influence

• 1) human chorionic gonadotropin on follicle growth in rabbits
• 2) estrogens on luteinization of follicles in rabbits
• 3) pregnanediol on luteinization of follicles in rabbits
• 4) placental lactogen on follicle growth in rabbits
• 5) human chorionic gonadotropin on the occurrence of hemorrhages in the cavity of the follicles and their luteinization in rabbits

39. The maximum height of the uterine fundus is observed

• 1) at 36 weeks
• 2) at 38 weeks
• 3) at 39 weeks
• 4) in 4O weeks
• 5) at the beginning of the 1st stage of labor

40. At 36 weeks of pregnancy, the fundus of the uterus

• 1) at the level of the navel, abdominal circumference - 8O cm
• 2) reaches the xiphoid process, abdominal circumference - 9O-95 cm, fronto-occipital size of the fetal head - 11-11.5 cm
• 3) in the middle of the distance between the navel and the xiphoid process, abdominal circumference - 85-9O cm, fronto-occipital size of the fetal head - 9.5-1O cm
• 4) in the middle of the distance between the navel and the xiphoid process, abdominal circumference - 1OO cm
• 5) in the middle of the distance between the navel and womb

41. To calculate the expected date of birth in primigravidas, it is necessary to add to the date of the first fetal movement

• 1) 16 weeks
• 2) 18 weeks
• 3) 2O weeks
• 4) 22 weeks
• 5) 25 weeks

- these are due to the current pregnancy sensations in a pregnant woman ( complaints), changes in her body and symptoms that the doctor identifies during examination. Signs of pregnancy differ depending on the timing of pregnancy, their objectivity and reliability, the presence of one or more embryos in the uterus, the sex of the child, the pathological course of pregnancy, as well as the location of the fertilized egg ( in or outside the uterus).

Pregnancy occurs after the implantation of a fertilized egg ( embryo) into the wall of the uterus. This process is called implantation. From this moment on, the woman is considered pregnant, and she begins to show signs of an “interesting situation.”

Pregnancy causes the following changes in the female body:

• anatomical changes– the uterus and mammary glands enlarge, the female figure changes;
• physiological– menstruation disappears, all organs begin to work more actively, hormonal levels change.

Signs of pregnancy are a consequence of these changes and can be determined during examination using laboratory tests ( chemical changes) and instrumental diagnostic methods.

What are the signs of pregnancy?

Signs of pregnancy can be subjective and objective. Subjective signs are felt by the woman herself; they may be associated with other pathologies or arise as a result of self-hypnosis, so they are not considered reliable. Objective signs are detected during examination by the woman herself or by a doctor, as well as during laboratory tests and instrumental studies. Objective signs do not always mean that a woman is definitely pregnant; some pathologies can cause such changes, or the sign can be overestimated by the doctor. Therefore, even objective signs of pregnancy differ in their reliability.

Depending on the reliability, all signs of pregnancy are divided into the following groups:

• dubious signs– are not associated with changes in the woman’s genitals or mammary glands, these are sensations that a woman experiences when pregnancy occurs;
• probable signs are symptoms associated with changes in the genitals and mammary glands, identified through routine examination, tests and gynecological examination ( they are called probable because they can occur in some other situations not related to pregnancy);
• reliable signs– indicate the presence of a fetus inside the uterus, detected during examination and research by a doctor, as well as using instrumental diagnostic methods.

	How do they manifest themselves?	Mechanism of occurrence
Questionable signs of pregnancy
Subjective signs	change in taste preferences ( craving for certain foods, sometimes even for inedible things); strengthening and changing the sense of smell ( aversion to odors and increased sensitivity to them); hearing enhancement; fatigue, irritability, drowsiness; frequent urination.	Disruption of natural adaptation processes due to pregnancy ( The female body undergoes restructuring at all levels) leads to disruption of the nervous and endocrine regulation of many organs. Increased urination is associated with irritation of the bladder and pressure on it from the enlarged uterus.
Objective signs	abdominal enlargement.	An increase in the size of the uterus with the fetus inside as the latter grows leads to an increase in the size of the abdomen. In addition, the belly “grows” due to an increase in the thickness of the fat layer as you gain weight during pregnancy.
	the formation of pigmentation on the skin of the face, on the stomach, nipples and around the nipples, on the external genitalia.	Pigmentation occurs due to an increase in the level of melanocyte-stimulating hormone, which stimulates the function of skin cells responsible for the accumulation of melanin pigment ( it determines skin color). In addition, estrogen production increases in early pregnancy ( female sex hormone) in the placenta, which stimulates the formation of the skin pigment melanin.
	pregnancy scars and stretch marks ( striae) on the skin of the abdomen.	The appearance of blue, purple or red stripes is caused by thinning of the skin under the influence of the pregnancy hormone progesterone. Rapid weight gain also contributes to skin stretching.
Possible signs of pregnancy
Objective signs	cessation of menstruation.	When pregnancy occurs, the level of the hormone progesterone ( pregnancy hormone) in women does not decrease ( as opposed to a non-pregnant woman before her period), it continues to be produced in the ovaries, so the lining of the uterus is not rejected, and menstruation does not occur.
	enlargement and engorgement of the mammary glands.	Under the influence of hormones secreted by the placenta and ovaries ( progesterone and estrogen), the mammary glands are prepared for feeding, the volume of glandular tissue increases and new ducts are formed. Some swelling of the breast tissue causes a feeling of tension and discomfort.
	secretion of colostrum from the mammary glands ( primordial milk).	Under the influence of hormonal changes in the mammary glands, the production of primary milk by its cells begins ( lactocytes). Colostrum is released from the nipple if you press on the mammary gland.
	positive pregnancy test.	A pregnancy test is positive if a hormone secreted by the fetal membrane, hCG, appears in a woman’s urine ( human chorionic gonadotropin). This sign is considered probable, since in some cases false negative results are possible in the presence of pregnancy or false positive results in other pathologies accompanied by an increase in hCG levels.
	changes in the size, shape, consistency and contractility of the uterus.	Associated with the presence of one or more fertilized eggs in the uterus, as well as changes in the woman’s hormonal levels, which affect the tone and softness of the uterus.
	loosening and cyanosis of the vagina and cervix.	Increased blood flow to the vagina and cervix causes these tissues to soften and change color.
Reliable signs of pregnancy
Objective signs	listening to the fetal heartbeat.	If the doctor listens with a stethoscope to a heartbeat that is much faster than the mother's ( 120 – 140 per minute) and is heard separately from it, then this is considered a reliable sign of the presence of a fetus in the uterus and indicates a developing pregnancy ( the heartbeat can be heard from 17 to 19 weeks of pregnancy).
	palpation of parts of the fetus and the sensation of its movement when palpated.	The use of obstetric techniques to palpate a woman’s abdomen from the outside makes it possible to clearly identify large parts of the fetus, while its movements and response to palpation are also clearly felt.
	detection of the fetus in the uterus during ultrasound examination ( Ultrasound) .	Ultrasound allows you to see the fertilized egg ( 2 weeks after conception), the fetus itself inside the uterus, its movements, heartbeat and heart contraction ( from 5 – 7 weeks of pregnancy).

Even if only 1 reliable sign of pregnancy is detected, this is considered sufficient to diagnose pregnancy. The remaining probable and doubtful signs are of value only when they are combined, since all these signs can be observed not only during pregnancy. This is especially important to consider in cases where a woman really wants to get pregnant.

Doubtful and probable signs of pregnancy can be confused with the following pathologies:

• Menstrual irregularities. If a woman is not protected, but her cycle is irregular ( menstruation is either delayed or occurs earlier), then a delay in menstruation due to hormonal imbalance can be mistaken for pregnancy. Irregular periods can be observed with tumors of the genital organs, diet ( fasting). That is why a delay in menstruation can be considered a sign of pregnancy only in combination with its other signs ( engorgement of the mammary glands, release of colostrum, signs revealed during a gynecological examination and, most importantly, with a positive pregnancy test).
• Vegetative-vascular dystonia ( neurosis, neurocirculatory dystonia) . Violation of the nervous regulation of vascular tone and the function of various organs leads to dizziness and fainting, irritability, fatigue, and sleep disturbances. Dizziness and fainting can also occur during pregnancy, especially in women prone to neuroses and suffering from anemia ( low levels of hemoglobin and red blood cells in the blood). That is why irritability and other symptoms cannot be associated solely with pregnancy.
• Diseases of the stomach, intestines, pancreas and gall bladder. These diseases cause symptoms such as nausea and vomiting. Nausea and especially vomiting are the most well-known signs of pregnancy, they appear with a frequency of 46% in all pregnant women, however, ordinary gastritis, irritation of the intestines, poisoning and other diseases of the digestive system that cause such symptoms should be excluded. It is characteristic that usually during pregnancy, vomiting does not bring relief, while in case of stomach pathology, removing food from it significantly alleviates the symptoms.
• Deficiency of vitamins, minerals and anemia. These diseases are accompanied by changes in taste and smell - they become distorted or there is a desire to eat “something unusual” ( chalk, hair, salty or sweet).
• Inflammation of the bladder and kidneys. These diseases are accompanied by frequent and painful urination, due to irritation of the bladder walls or an infection affecting the kidneys.
• Mastopathy. Mastopathy is a hormonal disease of the mammary glands, which is characterized by the proliferation of glandular tissue or ducts of the mammary gland against the background of hormonal imbalance. Mastopathy also causes engorgement of the mammary glands and even quite intense pain associated with swelling of the gland.

Such a sign as fetal movement, which is felt by the mother herself, is not considered reliable. Firstly, a woman may mistake intestinal contractions for fetal movement, and secondly, fetal movements are not felt until 18–20 weeks of pregnancy ( during the first pregnancy - at 20 weeks, and during subsequent ones - 2 weeks earlier).

Possible signs of pregnancy can be detected using the following tests:

• palpation of the mammary glands;
• examination of the external genitalia and vagina;
• examination of the vagina and cervix using mirrors ( special gynecological instrument);
• bimanual gynecological examination;
• pregnancy test.

An examination by a gynecologist is carried out on a gynecological chair, which has footrests. The woman lies down on this chair so that her buttocks are located on the edge of the chair, and places her legs on the supports. This position allows the gynecologist to perform a two-handed ( bimanual) examination of the vagina and cervix. Pregnancy changes the uterus. It is these changes that the obstetrician-gynecologist should identify. Identifying these signs also allows you to determine the approximate duration of pregnancy, however, they are not reliable signs, since the uterus can be enlarged due to other reasons.

With a two-hand examination, the gynecologist identifies the following signs of pregnancy:

• enlarged uterus– at 5–6 weeks of pregnancy, the uterus acquires a spherical shape ( non-pregnant pyriform uterus), by the 8th week of pregnancy the uterus doubles in size, by 10 - three times, and by 12 - 4 times;
• ridge-like projection on the anterior surface of the uterus– determined by palpation during vaginal examination;
• asymmetry of the uterus ( increasing and changing its shape) – the area of ​​the uterus where the embryo has implanted bulges, so the uterus takes on an irregular shape, which is determined at 7–8 weeks of pregnancy and disappears by the tenth;
• softening of the isthmus of the uterus ( segment between the body of the uterus and its cervix) – occurs under the influence of the pregnancy hormone progesterone, determined by touch by the doctor, and due to the softness of the isthmus, the fingers of the doctor’s inner and outer hands converge in the area of ​​the isthmus, which is considered a sign of pregnancy;
• increased uterine contractility– while palpating the uterus, its response to such irritation occurs, and it becomes denser due to muscle contraction.

Depending on the size of the uterus, the timing of pregnancy is determined as follows:

• 5 – 6 weeks– spherical shape during two-handed examination;
• 8 weeks– the uterus is the size of a woman’s fist;
• 10 weeks– the size of the uterus corresponds to the size of the head of a newborn baby;
• 16 weeks– the uterus can be felt above the womb;
• 20 weeks– the uterus can be felt 3 transverse fingers above the pubis;
• Week 24– the uterus can be felt at the level of the navel;
• Week 28- uterus above the navel.

Signs of pregnancy on ultrasound

Pregnancy can be seen on ultrasound 3 weeks after conception. At this stage, an ultrasound shows a rounded formation in the wall of the uterus, which does not reflect the echo signal well, that is, it transmits it, and therefore has a black color ( this is called a hypoechoic structure) is a fertilized egg. From 4–5 weeks of pregnancy you can see the embryo; it has a positive echo signal ( white colors on echo). The diameter of the fertilized egg at this stage is less than 0.5 cm. The future fetus can be clearly distinguished when its size at least doubles, that is, the diameter is 1 cm. To do this, you need to wait until the 7th week of pregnancy. At week 9, the fetal head is visible separately. At this stage, contractions of the fetal heart can also be seen. By week 10, the entire uterine cavity is already filled with fertilized egg.

Ultrasound is performed in the usual way ( the sensor is placed on the abdominal wall) or through the vagina. Last method ( transvaginal ultrasound) allows you to detect the fertilized egg 1 - 1.5 weeks earlier than a regular ultrasound.

When do signs of pregnancy appear?

Depending on the time of occurrence, pregnancy signs can be divided into early pregnancy signs and late pregnancy signs. Early signs of pregnancy are signs that can be detected before the 12th week of pregnancy, that is, these are all doubtful and probable signs. Signs of late pregnancy are determined from 18 to 20 weeks of pregnancy, that is, they already include reliable signs. The very first signs of pregnancy can be detected even before your period is missed.

Before your period is missed, the following symptoms may indicate pregnancy:(first signs of pregnancy):

• Spotting that is red, pink or brown. These discharges occur due to implantation ( implementation) fertilized egg into the uterine wall. For implantation, embryo enzymes destroy the surface layer of the uterine lining in a limited area to make room for implantation. Such local destruction is accompanied by bleeding, blood is released from the genital tract in the form of spotting. This vaginal discharge lasts 1 to 2 days and is often perceived by a woman as menstruation.
• Maintaining elevated body temperature before menstruation. A woman who is planning a pregnancy usually monitors changes in body temperature ( measured in the rectum) throughout the menstrual cycle. This is necessary to determine the period that is favorable for conception. Normally, before menstruation, a decrease in body temperature occurs, as the production of progesterone ( female sex hormone 2 phases of the cycle) gradually decreases. Progesterone affects the thermoregulatory center in the brain, causing an increase in body temperature. If pregnancy has occurred, the production of progesterone continues, and the body temperature remains at 37 - 38ºC.
• A sharp drop in body temperature. If, after the middle of the cycle, before the start of the next menstruation, a woman observes a 1-2 day sharp drop in temperature, then this may be a sign of pregnancy. This symptom is called implantation retraction. This retraction is explained by a temporary cessation of secretion of the hormone progesterone in the ovaries ( they have not yet received the signal that pregnancy has occurred and that they need to continue to secrete progesterone). There is another reason. During conception, estrogen is produced - this is the second female sex hormone, the effect of which is opposite to that of progesterone, it causes a decrease in body temperature.
• Nagging pain in the lower abdomen– occur simultaneously with spotting and are associated with the same process of implantation of the fertilized egg.
• Breast tenderness and engorgement– occurs due to hormonal changes due to pregnancy.

Signs of early pregnancy include:

• delayed menstruation;
• bad feeling;
• mood swings;
• dizziness;
• change in taste, smell;
• frequent urination;
• nausea, vomiting ( from 2 weeks of pregnancy);
• increased appetite ( from 4 weeks of pregnancy);
• drowsiness or insomnia;
• positive pregnancy test;
• appearance of the amniotic cavity ( cavity filled with amniotic fluid) on ultrasound, a thin strip inside this cavity, which is the future embryo ( detected 3–4 weeks after conception).

Signs of late pregnancy include:

• listening to the fetal heartbeat;
• detection of the fetus on ultrasound;
• palpation of large parts of the fetus;
• fetal movement felt by the doctor.

You can find out the sex of the child using ultrasound data. This can usually be done between 12 and 16 weeks of pregnancy. However, the doctor cannot always do this accurately, even in later stages due to the position of the fetus. At the same time, there are many signs or signs, as well as the feelings of the woman herself during pregnancy, which indicate that a boy or girl is growing in her stomach. These signs are mainly due to the level of sex hormones. If the parents managed to conceive a boy, then the female body will have more male sex hormones, which are necessary for the growth of a male fetus. It is the ratio of male and female sex hormones that determines exactly what phenomena will occur in the body of a pregnant woman, in addition to the main signs of pregnancy.

Gender of the child by signs during pregnancy

Sign	Pregnancy with a boy	Pregnancy with a girl
Nausea	Morning sickness in the first months of pregnancy is absent or insignificant ( it occurs only in half of pregnant women; this is not a necessary sign).	Severe nausea in the morning in the first months of pregnancy.
Fetal heart rate (heartbeat)	Less than 140 beats per minute.	More than 140 beats per minute.
Belly shape	The round belly, reminiscent of a basketball, protrudes forward.	The belly has an oblong shape, more “flat”, reminiscent of a melon.
Height of the enlarged abdomen	The stomach is low.	The stomach is located high.
Breast changes	Marked darkening of the peripapillary area.	Marked enlargement of the mammary glands, with the left breast being larger than the right.
Taste preferences	A woman is “pulled” to eat salty and sour foods, and there is a desire to consume meat and dairy products ( cheese, milk).	A woman is “drawn” to fruits, she especially likes oranges, a sweet tooth develops, the woman prefers not to eat the crust of bread, only the crumb.
Woman's appearance	The woman becomes prettier, her nose becomes somewhat sharper.	Tendency to age spots on the face, acne, swelling of the face ( beauty temporarily “passes” to the girl).
Skin change	Dry palms.	Soft palms.
Mood changes	The mood is cheerful, performance is high, weakness is not felt.	She constantly feels sleepy, the woman is irritable, whiny, and her mood often changes.
Temperature in the lower extremities	Coldness of the lower extremities.	Warm lower extremities.
Headache	A common sign.	Not typical.
Hair Growth	Hair on your legs grows faster and hair appears on your stomach.	There is no excess hair growth observed. The expectant mother's hair may acquire a red tint.
Weight gain	Gaining excess weight is not typical, since boys “prefer” more protein foods, which require more energy to digest.	Rapid weight gain, fat is deposited in the thighs and buttocks, the figure “blurs”.
Appetite		May be missing.
Urine color	Bright yellow.	Light yellow, dull.

Signs of multiple pregnancy

A multiple pregnancy is a pregnancy with more than 1 fetus. The likelihood of multiple pregnancies increases with age, and is more common if one of the future parents had twins in the family, as well as if the pregnancy resulted from IVF. Parents usually find out about the presence of twins through an ultrasound, but there are other signs that indicate a pregnancy with twins or triplets.

The following signs indicate a multiple pregnancy:

• the size of the uterus does not correspond to the duration of pregnancy;
• the circumference of the abdomen and its “height” are much larger than expected for this period;
• the doctor feels more than 3 large parts of the fetus;
• when listening with a stethoscope, 2 heartbeats are determined, which differ from each other in frequency and the best point of listening, and between them there is a “silence” zone where tones are not heard;
• the difference in the heart rate of twins is more than 10 beats at different points, which is determined by a special apparatus ( cardiac monitor);
• when determining the level of hCG in the blood, its level is 2 times higher;
• tendency to edema of the lower extremities ( heavy load on internal organs and especially on the kidneys);
• rapid onset fatigue;
• more severe toxicosis ( severe nausea and vomiting, severe engorgement of the mammary glands);
• tendency to constipation;
• early fetal movement ( If a woman usually feels the baby’s movements from 18 to 20 weeks of pregnancy, then in case of multiple pregnancy – from the 15th week).

A frozen pregnancy is a non-developing pregnancy when the normal course of pregnancy is disrupted and the development of the embryo stops in its early stages or the death of the fetus occurs in the later stages of pregnancy. In this case, parts of the fertilized egg, embryo or fetus continue to be in the uterine cavity.

Signs of a frozen pregnancy include:

• low level of hCG in the blood ( hormone secretion stops);
• The uterus on ultrasound and when felt by a doctor is smaller in size than it should be at this stage of pregnancy ( at any time);
• absence of yolk sac ( in the early stages) or the embryo itself inside the fertilized egg;
• absence of fetal heartbeats ( at 7–8 weeks of pregnancy);
• absence of fetal movements according to ultrasound ( up to 22 weeks of pregnancy).

Signs of pregnancy after IVF

IVF or in vitro fertilization is fertilization outside the female body, followed by the introduction of embryos into the uterine cavity. Signs of pregnancy after IVF do not differ from those during natural pregnancy. The main point to pay attention to is the possibility of a false-positive pregnancy test and the timing of the appearance of signs of pregnancy.

The embryo is introduced into the uterine cavity on days favorable for its implantation, that is, penetration into the wall of the uterus. However, it is impossible to know the exact date of this implantation. This can happen within a few hours or up to a week after the embryo transfer procedure. Implantation itself lasts up to 3 days. The timing of the appearance of signs also depends on the “age” of the embryos. Sometimes three-day-old embryos are implanted, and sometimes five-day-old ones. If three-day-old embryos are introduced into the uterus, then signs of pregnancy may appear several days later than with the introduction of five-day-old embryos.

Thus, you should expect the first signs of pregnancy after IVF 12 to 14 days after the embryos are introduced into the uterus. After 12–14 days, the woman should take a pregnancy test. A regular pregnancy test is done on day 14 after embryo transfer, and a blood test to quantify hCG is done on day 12. The fact is that before IVF, hCG is used to stimulate the ovaries, and using the test earlier than 2 weeks can lead to a false positive result, that is, the appearance of two stripes in the absence of pregnancy. If the hCG test after IVF is positive, it is repeated 2 days later. The success of IVF and pregnancy can be confirmed 3 weeks after the embryos are inserted, when the woman undergoes an ultrasound scan.

An ectopic pregnancy is a pregnancy in which the fertilized egg implants outside the uterine cavity. Ectopic pregnancy includes cases of attachment of the fertilized egg to the ovaries, the wall of the fallopian tube, abdominal organs, as well as in the cervical canal, in the additional horn of the uterus ( with a congenital defect), in the mesentery of the uterus and inside its ligaments.

During an ectopic pregnancy, a woman initially experiences the same signs as during a normal pregnancy - doubtful and some probable ( for example, a positive pregnancy test). Signs of an ectopic pregnancy itself are detected 5–7 weeks after conception.

Signs of an ectopic pregnancy include:

• severe pain in the lower abdomen;
• shoulder pain ( occurs reflexively due to nerve irritation);
• pain during bowel movements;
• bleeding from the genital tract;
• severe dizziness.
• painful formation that can be felt in the area of ​​the uterine appendages;
• detection of the fertilized egg outside the uterine cavity according to ultrasound data.

The doctor suspects an ectopic pregnancy in cases where, against the background of a positive pregnancy test, there is no fertilized egg in the uterine cavity.

If an ectopic pregnancy is suspected, an ultrasound of the uterine appendages and abdominal cavity is urgently performed, and then a laparoscopic examination. Laparoscopy is a method of examining the abdominal organs using a tube with a camera at the end. It is inserted through a puncture on the anterior abdominal wall. The advantage of this method is that a diagnostic study, if necessary, turns into a surgical operation and makes it possible to remove an ectopic pregnancy, preventing life-threatening complications for the woman.

Signs of false pregnancy

False pregnancy is considered a mental illness. It is also called an imaginary or imaginary pregnancy. It is associated either with a woman’s great desire to become pregnant, or with a great fear associated with an unwanted pregnancy after sexual intercourse. In both cases there is strong self-hypnosis. A woman may experience doubtful and some probable signs of pregnancy - taste perversion, nausea, vomiting, abdominal enlargement, delayed menstruation, pigmentation, weight gain. The woman may even feel that the fetus is moving. She usually mistakes intestinal contractions for fetal movement. In very rare cases, a gynecological examination and bimanual examination may reveal changes in the shape and consistency of the uterus. Typically, these changes are associated with a woman’s hormonal background, which can “adapt” to the idea of ​​pregnancy instilled in her.

No reliable signs of pregnancy are detected during a false pregnancy. Ultrasound does not detect the fetus in the uterus, heartbeats cannot be heard, large parts of the fetus cannot be palpated. The pregnancy test is negative ( in rare cases with malignant tumors it can be positive). This condition requires treatment by a psychiatrist, but such patients are almost impossible to respond to psychotherapy.

Can a high temperature be a sign of pregnancy?

An increase in body temperature may be a sign of pregnancy. If a woman measures the temperature of her internal organs every day during her cycle ( basal temperature) in the rectum, then she notices that after the middle of the cycle the body temperature rises to 37.2 - 37.5ºC, and then gradually normalizes. This phenomenon is explained by the production of the female hormone progesterone, which affects the thermoregulation center in the brain. When pregnancy occurs, this hormone continues to be produced ( it is necessary to maintain pregnancy), therefore, normalization of body temperature before the next menstruation does not occur. Body temperature lasts up to 12 weeks, and it can reach 38ºC.

What are the most reliable signs of pregnancy?

The most reliable signs of pregnancy are detected using ultrasound ( Ultrasound), and both in the early stages of pregnancy ( up to 12 weeks), and in later stages ( after 18 – 20 weeks). Ultrasound in the early stages detects either the embryo itself ( it still looks like a thin bright strip inside the cavity of the fetal egg), or elements of the fertilized egg ( fluid-filled cavity, yolk sac). At the 9th week of pregnancy, you can already see contractions of the fetal heart on an ultrasound and turn on the mode of listening to the heartbeat.

Reliable signs of pregnancy appear closer to 18 - 20 weeks of pregnancy. Ultrasound can detect signs of pregnancy as early as 3 weeks after conception.

Other reliable signs of pregnancy are:

• listening to a very rapid fetal heartbeat ( 140 beats per minute or more) using a regular stethoscope ( a tube);
• palpation of the head and other large parts of the fetus ( for example, legs) doctor;
• feeling of fetal movements by the doctor during examination.

It is important to know that the sensation of fetal movement cannot in any way be considered a reliable sign if it is felt not by a doctor, but by the woman herself. A woman may mistake the process of contraction of the intestinal walls for the movement of the baby ( sometimes even very strong contractions). If the doctor himself, during the examination, feels large parts of the fetus and at the same time feels its independent, as if in response, movements, then this is considered a reliable sign of pregnancy.

A positive pregnancy test is not a reliable sign of pregnancy because it detects the presence of a hormone in a woman's urine ( HCG – human chorionic gonadotropin), secreted by the membranes of the fruit, and not the fruit itself. This means that in some cases a pregnancy test may be falsely negative ( There is a pregnancy, but the hormone level is not yet high enough or the test was performed incorrectly) or false positive ( the test shows 2 lines, but the reason for the increase in hCG levels is not pregnancy).

Can abdominal pain be a sign of pregnancy?

Some women report nagging pain in the lower abdomen or stabbing sensations, which are explained by the implantation of a fertilized egg into the wall of the uterus. These symptoms appear 4–5 days after fertilization or 7–10 days after ovulation ( the process of releasing an egg from the ovaries mid-cycle). Typically, abdominal pain is accompanied by slight bleeding from the vagina ( brown or pink). This bleeding is also associated with the process of implantation of the embryo, because it must create a bed for itself inside the wall, and for this it is necessary to slightly destroy the surface layer of the uterine mucosa and create a depression in it.

Abdominal pain can be a sign of more than just intrauterine pregnancy ( inside the uterine cavity), but also ectopic. In this case, they intensify, cause severe discomfort and disrupt the woman’s performance. During tubal pregnancy ( inside the fallopian tube) there is a risk of rupture of the tube wall, and in case of ovarian pregnancy - bleeding. Such complications cause sharp, severe pain in the lower abdomen, a state of shock ( fainting, drop in blood pressure), increased heart rate and require emergency surgery.

To avoid such complications in the event of a delay in menstruation and a positive pregnancy test, if abdominal pain occurs, you should contact a gynecologist at the antenatal clinic and have an ultrasound done ( ultrasonography) uterus.

On what day of the cycle do signs of pregnancy appear?

The first signs of pregnancy may appear as early as 7 days after ovulation ( this is the name of the day in the middle of the cycle when a mature egg is released), if conception occurred a few days before ovulation or on the day of ovulation. To identify these signs, you need to measure the basal temperature in the rectum, and also pay attention to the nature of the vaginal discharge. With successful conception and implantation of a fertilized egg into the wall of the uterus, a change in hormonal levels occurs. The ovaries continue to secrete the hormone progesterone. This female sex hormone causes an increase in body temperature, therefore, during pregnancy, the second phase ( after ovulation) body temperature will remain at 37 – 37.5ºС until the day of the expected next menstruation and longer ( up to 12 weeks of pregnancy).

At the same time, a woman should know that for 1 - 2 days the body temperature can drop sharply and this does not mean that the pregnancy has been terminated. Before implantation ( implementation) embryo into the uterus, the female body still lives according to the old rhythm and does not know about successful conception, so the level of progesterone may decrease. If this happens, the body temperature also drops, which is called implantation retraction. After the embryo is implanted into the uterus, progesterone production resumes and body temperature “jumps” again.

Even before the delay of menstruation, during pregnancy, nausea, vomiting, engorgement of the mammary glands, and changes in sexual desire may appear ( it usually disappears), dizziness. All these signs of pregnancy are observed 4 to 5 days after conception ( if a woman knows the exact day of conception) or 7–10 days after ovulation.

A pregnancy test should be taken 7 to 10 days after the expected day of conception. If the test is highly sensitive, it will show a positive result already at this stage, but in some cases this sign of pregnancy may appear only 12–14 days after conception.

Is it possible to have no signs of pregnancy during pregnancy?

Pregnancy is always accompanied by signs, but in the early stages a woman may not be aware of it, especially if she uses contraception or has irregular periods. In this case, pregnancy does not make itself felt for the time being. In addition, signs such as nausea, vomiting, weakness and other subjective sensations can be mistaken for illness, a cold, or poisoning. A woman may attribute the disappearance of her period to stress or diet. The abdomen also does not increase until the 12th week of pregnancy, since before this period the uterus is still within the pelvis ( below the womb). Sometimes pregnancy is accompanied by bleeding from the vagina. They are perceived by a woman as menstruation ( last 1 – 2 days), and she doesn't think about pregnancy.

Can signs of pregnancy occur while taking birth control pills?

Taking birth control pills protects against unwanted pregnancy, but there are cases when this method of contraception does not work and pregnancy occurs. Signs of pregnancy while taking birth control pills are no different from signs of pregnancy without taking these pills. The first signs of pregnancy can easily be confused with a cold, gastritis, or attributed to poor diet or stress ( even a delay in menstruation). Perhaps the most characteristic sign of pregnancy while taking birth control pills is breast changes. It becomes painful, enlarges, the circles around the nipples darken, the nipples become very sensitive, and discharge from the nipples is observed. This symptom is difficult to attribute to any other reason. Sometimes this occurs with severe hormonal imbalance, but in any case, such a sign forces the woman to take a pregnancy test and consult a gynecologist.

You should think about pregnancy while taking birth control pills in the following cases:

• Irregular taking of pills, frequent missed doses, especially in the middle of the cycle;
• taking different types of birth control pills ( they can neutralize each other's effects);
• diseases of the digestive system ( disrupt the absorption of the pill, and the level of hormones in the blood drops sharply);
• taking medications that may interfere with the effects of birth control pills;
• drinking alcohol while taking birth control pills.

Can there be signs of pregnancy while breastfeeding?

Pregnancy cannot occur in the first 4 to 6 weeks after birth due to the woman’s hormonal levels ( hormones for stimulating the ovaries are not yet produced, as during pregnancy), but a woman can become pregnant even in the first 6 months, even if she is breastfeeding. Breast milk is produced when stimulated by the hormone prolactin. The same hormone simultaneously suppresses the function of the ovaries - the egg does not mature, therefore, if we consider breastfeeding as a method of contraception, then it can only be used for 6 months after childbirth and subject to certain rules. During this period, the woman should breastfeed the baby only, and at the request of the child. It is also important that the intervals between feedings do not exceed three hours during the day, and 6 hours at night, that is, it is mandatory to feed the baby once at night. If a child eats formula, he will eat less milk, which means that the milk production process will become irregular and incomplete.

In all other cases, the work of the ovaries can resume during breastfeeding, the egg can mature and be released from the ovary, so the appearance of signs of pregnancy cannot be ruled out during breastfeeding.

Signs of pregnancy while breastfeeding include:

• Lack of menstruation. 1.5 months after giving birth, a woman may begin menstruation; they can be irregular and short. It is not possible to accurately calculate the onset of the next period. If a woman does not get her period after 6 months of breastfeeding, this may be a sign of pregnancy.
• Sore nipples. When pregnancy occurs, progesterone production increases sharply. This female hormone is needed to relax the uterus, but at the same time it affects the mammary gland and increases the sensitivity of the nipples. If a nursing mother becomes pregnant again, she suddenly notices that feeding the baby has become quite painful due to irritability of the nipples.
• Increased appetite. A new pregnancy while breastfeeding a newborn requires more energy, so the woman feels constant hunger.
• Reducing the amount of milk. A “new” pregnancy again changes a woman’s hormonal background. If during breastfeeding the main hormone is prolactin, then during pregnancy it is progesterone. Progesterone suppresses milk production, so during pregnancy and breastfeeding, milk becomes less and less.
• Increase in basal temperature. Basal temperature is the temperature of internal organs, which should be measured in the vagina or rectum. This symptom also occurs under the influence of the hormone progesterone. It acts on the brain and increases body temperature to an average of 37.5ºC. However, during breastfeeding, when the temperature rises, an infectious process should be excluded as one of the causes of fever.
• White vaginal discharge. This discharge is not considered a characteristic sign of pregnancy, but when combined with other phenomena, you should pay attention to it. White discharge is of greater importance during breastfeeding, since the hormonal background of a woman during breastfeeding does not cause mucus changes characteristic of a non-pregnant woman during the menstrual cycle. The mucus of a non-pregnant and non-breastfeeding woman periodically becomes transparent, which indicates the release of a large amount of the hormone estrogen. This does not happen for a nursing mother, because the menstrual cycle has not yet started. Therefore, you should pay attention to any sudden changes in the color and consistency of vaginal discharge during breastfeeding.
• Stomach ache. During feeding, uterine contractions intensify. A woman may feel quite severe pain. This is also observed in the absence of pregnancy during the feeding period, but if pain is felt outside of feeding in the form of pulling sensations in the lower abdomen, then this may indicate pregnancy. Moreover, very severe pain can be associated with an ectopic pregnancy, so special attention should be paid to this symptom.
• Changing the child's behavior. If a nursing mother becomes pregnant again, progesterone affects the function of the mammary glands. It can change the taste of milk - the baby usually does not like this, and he begins to cry and be capricious.

Signs of early pregnancy