=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.