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1. Sunil Kumar Daha

2. First trimester
Subjective symptoms
• Amenorrhoea
• Morning sickness
• Frequency of micturation
• Breast discomfort
• Fatigue
Objective signs
• Breast changes
• Pelvic changes
• uterine signs

3. • Amenorrhea:
• cyclic bleeding may occur, which is scanty and lasting for shorter duration
• Morning sickness:
• appears soon following the missed period
• intensity varies from nausea, loss of appetite or even vomiting
• Frequency of micturition due to:
• Resting of bulky uterus on the fundus of bladder
• Congestion of bladder mucosa
• Change in maternal osmoregulation

4. • Breast changes: evident between 6-8 weeks and nipple
and areola become more pigmented
• Per abdomen: uterus remain pelvic organ until 12th week
and just felt per abdomen as a supra pubic bulge

5. Pelvic changes
• Jacquemier’s or Chad wick’s sign- dusky hue of vestibule and anterior
vaginal wall visible at about 8th week of pregnancy due to local
vascular congestion.
• Vaginal signs-
• Walls softens
• Copious mucoid discharge at 6th week
• ↑pulsation felt through lateral fornices at 8th week called Osiander’s sign.
• Cervical signs-
• Soft at 6th week(Goodell’s sign)
• On speculum examination bluish discoloration seen

6. Uterine signs
• Size, shape, symmetry
• enlarged to size of :
• hen’s egg at 6th week,
• cricket ball at 8th week
• fetal head by 12th week.
• Feels soft and elastic
• Hegar’s sign
• Upper part of body of uterus is enlarged
• Lower part of body is empty and soft
• Cervix is comparitively firm
• Palmer sign
• Regular rhythmic uterine contraction elicited during bimanual
examination

8. 2nd trimester
Symptoms
• Amenorrhoea continues
• “Quickening”(feeling of
life)
• Perception of active
fetal movements.
• Usually at 18th week.
• Progressive enlargement
of lower abdomen
G/E
• Choloasma- pigmentation over
forhead and cheek
• Breast changes
• Enlarged with prominent veins
• Secondary areola
• Colostrum thick and yellowish

9. Abdominal examination
• Inspection
• Linea nigra visible from symphysis pubis to ensiform cartilage.
• Pink and white striae visible in lower abdomen
• Palpation
• Increased fundal height with progressive enlargement of uterus.
• Uterus feels soft and elastic and ovoid shape
• Braxton- Hicks contractions are evident(Irregular, spasmodic, infrequent
and painless)
• Palpation of fetal parts and active fetal movement can be felt at 20th
week.

10. Level of fundus uteri at different weeks

11. Auscultation:
• Fetal heart sound detected between 18-20th weeks of pregnancy
• FHR: 110-160 beats/min
Vaginal examination:
• Bluish discoloration of vulva, vagina and cervix
• Internal ballottement: can be elicited between 16th -28th weeks

12. Third Trimester
• Symptoms
• Amenorrhea persists
• Enlargement of abdomen
• Lightening: due to engagement of the
presenting part
• Frequency of micturition reappears
• More pronounced fetal movement

13. Signs
• Cutaneous changes:  pigmentation and striae
• Uterine shape is changed from cylindrical to spherical
• Symphysis fundal height
• Fetal movement are easily felt
• Palpation of fetal part
• FHS is heard distinctly in corresponding to presentation and position of the fetus

14. References
• Cunningham F. G. et al. Williams obstetrics, 24th edition
• Dutta D. C., Konar H., DC Dutta’s textbook of obstetrics, 8th edition

15. Thank you