How do you tell you are pregnant? Signs and symptoms of pregnancy
“Baby, I think am pregnant”. This is a statement that for many couples, once stated, evokes several responses. Most of the time the man involved would ask, “Are you sure?”. This definitely requires the woman to give several reasons to support her suspicions. So question is, how did couples proceed in the era before conventional medicine, when there were no lab tests, no ultra sounds, no contraception and sex was probably more rampant than present? The manifestations of pregnancy are many and we shall group them into three for discussion:
1. Presumptive manifestations
2. Probable manifestation
3. Positive manifestation
Presumptive manifestations
Missed Period (Amenorrhea): This is what raises the antennae for most women. A missed period is a fairly reliable symptom in those who have regular periods. Once conception has occurred, the ovary releases increased levels of the sex hormones oestrogen and progesterone, which prevent further menstruation (otherwise, the uterine lining would be shed together with the developing embryo). As pregnancy progresses, the developing placenta takes over this function. Conception usually occurs in the fallopian tube and the fertilized ovum is transported to the uterus over days and then implants into the uterus lining. Some women at the time of implantation experience slight bleeding (spotting) which may be confused for a period. Amongst many women, menstrual periods are notoriously irregular, thereby creating confusion, and reducing the reliability of a missed period in diagnosing pregnancy. Those with regular periods are advised to wait at least ten days after the expected date before presuming pregnant. Other causes of missed period include emotional tension, long standing medical conditions of whichever nature, starvation (anorexia), use of some drugs especially those that affect hormones, and the use of contraception. Needless to say that pregnancy can only be presumed to have occurred if in the period after the last menses, one has engaged in unprotected peno-vaginal intercourse, or other activity that can lead to conception.
Nausea and Vomiting (Emesis gravidarum): This is what lay people call “morning sickness”. However this is a misnomer; although it is common in the morning, it can occur at any time of the day. It occurs in about half the pregnancies and is most severe between the 2nd and 12th week of pregnancy. This coincides with the peak of production of the pregnancy hormone, human chorionic gonadotropin (hCG), which has been touted to be the cause. It may be precipitated by cooking odours, pungent smells and certain sights. Emotional tension causes an increase in its severity. Twin pregnancies and other multiple pregnancies are also associated with increased severity. Molar pregnancy, where the fertilized ovum does not develop into a baby but divides into a mass of vesicles, is also associated with increased severity. Its effects are made better by provision of emotional support and eating small frequent meals, especially light dry foods. A late night snack helps in reducing morning symptoms. High doses of vitamin B6 and preconception use of vitamins have also been thought to reduce its severity. The use of anti-nausea medications is avoided and used only as a last resort. In some women, the symptom is so severe that they cannot retain any food and they end up weak and dehydrated, the effects of their illness inducing in them emotional stress and thereby causing a vicious cycle. This now becomes a disease entity known in medical parlance as hyperemesis gravidarum; it necessitates admission and treatment with intravenous fluids and other medication. In the second trimester, most women have complete resolution or a significant reduction of the symptoms, but for an unfortunate few, it may last throughout pregnancy.
Breast Pain (Mastodynia): The breasts in pregnancy enlarge in response to increasing levels of the pregnancy hormones in preparation for breastfeeding. This rapid increase in size leads to the development of stretch marks (striae). Rarely, the growth may become so extensive and develop into a life threatening condition called gigantomastia, which requires surgical correction. The rapid breast enlargement is associated with slight tingling sensation and in some cases pain; it is comparable to an exaggeration of the premenstrual breast discomfort. The veins on the breast become more prominent. The nipple (which becomes more erectile) and the surrounding dark area (areola) become darker in colour. The areola has pimple like glands called montgomery tubercles that also become more prominent. In the second trimester the breast may start secreting small amounts of colostrum. The changes in colour that come in the first pregnancy are permanent and irreversible and as such, this can only be used as a presumption of the first pregnancy.
Foetal Movements (Quickening): At around 18 weeks for 1st pregnancy and earlier in subsequent pregnancies the mother perceives the first foetal movements in her uterus. Intestinal peristaltic movements may be confused for foetal movements for the inexperienced and the over eager.
Change in Urinary patterns: The enlarging uterus reduces space in the lower tummy in early pregnancy, therefore the bladder does not fill as fully as previously, and therefore pregnant women tend to pass urine more frequently. Due to hormonal and other changes that occur in pregnancy, these women are also prone to urinary tract infections that manifest as a burning sensation while passing urine, frequent passage of urine, and lower abdominal pain. In some the, infection does not become manifest (asymptomatic bacteria in urine).
Changes in Vaginal discharge: Ordinarily, the vaginal mucus becomes lighter and more during ovulation. With conception precluding ovulation till end of pregnancy, the vaginal discharge becomes thick and acidic. This is conducive for yeast infections which in turn are common in pregnancy. Rise in body temperature: Women who had been taking their body temperatures for three weeks prior to conception will realize a rise of about 0.5?C that will occur soon after ovulation and be sustained into pregnancy.
Skin changes: The mask of pregnancy, which is a darkening of the forehead, bridge of the nose and cheek bones is known in medical terms as chloasm. This is more pronounced in darker skinned people and is made more prominent by exposure to sunlight. It occurs mainly after the 16th week of pregnancy. As the breast changes occur, there is also a dark line that develops from the umbilicus to the pubis, known in medical lingo as Linea Nigra. This caused by increased levels of the pigment hormone Melanocyte Stimulating Hormone (MSH) that occurs in pregnancy. This change is permanent, and allows one to identify women who have been pregnant before at the beach (in their bikinis) or in the streets (in their tumbo cuts)! Characteristic skin capillaries (spider telangiectasiae) and stretch marks also increase in pregnancy.
Probable Manifestation
The growth of the foetus and uterus and consequent enlargement of the abdomen is usually the most easily recognizable sign of pregnancy. However this comes late in the pregnancy. The rate of enlargement is more pronounced in the second trimester as the enlarging uterus comes out of the pelvis. However many illnesses are characterised by abdominal swelling in general or even uterine swellings. Obstetricians may also observe several characteristic changes that occur on the uterus and the cervix, including change in colouration, consistency, flexibility and blood flow. These, though pertinent, are to the lay technical and thus do not merit elaborations in this site. Details can be obtained in most standard texts of midwifery or obstetrics. The uterus starts having occasional painless contractions, felt as pressure; in technical jargon they are referred to as Braxton hicks contractions, mainly after the 28th week of pregnancy and can be reduced by walking or exercise. The various body ligaments become relaxed, especially in the pelvis, to allow for stretching during delivery. This is also responsible for various body aches that occur in pregnancy most notorious being back pain.
Positive Manifestation
Using an ultra sound , one can demonstrate activity of the foetal heart by 5 to 6 wks of pregnancy and finger and limb movements by the 10th week. The obstetrician can also hear the baby’s heart sound using an equipment called Doppler as early as the 10th week.
Pregnancy Test: Most current pregnancy tests are based on the detection of the hormone, human chorionic gonadotropin (hCG) which is produced by the cells that develop into a placenta. These cells are active by the 8th day after fertilization, and a very sensitive test can detect the hormone in maternal blood on the 9th day. This corresponds to the 23rd day of a 28 day menstrual cycle. This hormone is passed out of the body through urine and can therefore be detected without pricks. Most available tests turn positive by one week after the missed period and increase in sensitivity with time, peaking at the 65th day after fertilization. Home pregnancy tests are less sensitive; to enhance their efficacy one is advised to use the early morning urine specimen (usually concentrated) and if they are negative, to repeat after two weeks. Some normal body hormones have similarity to hCG and old test kits could not distinguish between them thereby giving falsely positive results. False positive results can also been seen in some women with immune disorders, and who have interacted closely with animals. This error is due to the fact that the test is based on the body’s antibody reaction.
In Conclusion Many women may have one or more of the following features without being pregnant. While suspecting pregnancy, one should have reasonable basis and there must have been unprotected sexual exposure accompanied by the above features. The more features are present, the more likely that one is pregnant.
Dr. Gwer Stephen Otieno
Obstetrician Gynaecologist
Nyamira District Hospital Kenya.
