Presumptive Signs or Earliest Evidence of Pregnancy

Absence of Menses

A missed menstrual period is usually the earliest evidence of pregnancy. A missed period in a woman between ages 15 and 45 with previously regular cycles suggests pregnancy as the most likely possibility. It is not a definitive sign, however, since there are many other causes for a delayed or even a skipped period.

Periods may be quite irregular toward the beginning and the end of the menstrual years, confusing the issue of whether or not a woman is pregnant. Recent childbirth, especially when a woman is nursing, may eliminate menses temporarily or lengthen the interval between periods .Illnesses, including untreated diabetes, thyroid gland disturbances, substance abuse, and high fever from infection may create menstrual irregularities. Severe malnutrition may lead to an absence of menstruation. Amenorrhea may occur in women who have lost weight rapidly on a very strict diet.

Ballet dancers and athletes, particularly those who train intensely for long-distance running, often stop menstruating. Psychological stress may also be responsible for the temporary disappearance of menses. Among the stresses might be adjustment to living in a new country or a change of occupation. Emotional upsets such as the death of a loved one can precipitate amenorrhea. Missed periods are not uncommon among young women who leave home for college.To confuse the issue further,you may be pregnant and still appear to menstruate during. early months. On close observation, such menstrual periods are different. Ordinarily they are shorter and scantier. A woman may menstruate 3 days instead of 5 at the normal time her period is due. A month later she menstruates half a day, the following month for an hour, and then her periods cease entirely for the remainder of pregnancy. Women may develop menstrual-like cramps at the time of the first missed period without any bleeding. They fully expect to menstruate each hour, but do not. The discomfort lasts for up to 3 or 4 days, then stops.

Breast Changes

Many women experience breast changes premenstrually. These changes include fullness and tenderness. These symptoms subside rapidly just before or with the onset of menstruation. When pregnancy occurs, the feelings of fullness and tenderness continue instead of disappearing, and become even more marked. In the very first weeks after conception, you may feel a tingling in your breasts, and they may become extra tender, with hypersensitive nipples. If you haven’t realized that your period is late, you may dismiss these feelings as premenstrual symptoms, but the tenderness usually is more intense than it is premenstrually. In fact, you may feel breast tenderness even before a missed period. In a second or later pregnancy, you will often recognize this intense sensitivity as an early sign of pregnancy.

Breast sensations in pregnancy usually are of short duration, the breasts remain large, but the feelings of tenseness and tenderness gradually disappear by the end of the third or fourth month of pregnancy. In preparation for lactation the mammary glands continue to increase in size during the remainder of pregnancy, the enlargement due in part to growth of the milk-secreting glandular tissue and in part to a greatly enriched blood supply. The latter is often manifested in the second half of pregnancy by the appearance of a delicate tracery of blue veins beneath the skin on the chest, especially noticeable in women with very fair skin.

The nipple and the colored circle of skin surrounding it-the areola­ enlarge and their pigmentation darkens. Arranged in a circular fashion around the periphery of the areola, near the skin edge, are a number of small, roundish elevations, or oil glands-in the inimitable words of William Fetherstone H. Montgomery, who first described them, “a constellation of miniature nipples scattered over a milky way.” These glands, called Montgomery’s glands or tubercles, become more prominent in pregnancy. In some women breast enlargement is accompanied by the formation of stretch marks in the skin, or striae. Since they appear more extensively over the abdomen.

Nipple Secretion

After the first few months a sticky, yellowish, watery fluid colostrum-may be expressed from the nipple by gently squeezing the breast. This finding is not absolute evidence of pregnancy, however. Women who have borne and nursed children may retain colostrum in the breasts for years. In the later months of pregnancy drops of colostrum may flow from the nipples spontaneously. As term is approached, the colostrum takes on an opaque, whitish appearance, more resembling milk.

Nausea and Vomiting

With today’s early pregnancy testing, most women already know :they are pregnant by the time they feel nauseated or vomit. However, nausea and vomiting in pregnancy are so common that they are considered reliable presumptive signs. These symptoms most frequently occur from 5 to 12 weeks after the last menstrual period, although you may reel nausea as early as 2 to 3 weeks after your last period. For some women this is the first clue that they are pregnant.

Nausea occurs in 50 to almost 90 percent of pregnant women and is often, though not always, accompanied by vomiting. In popular speech these symptoms have been cheerfully termed morning sickness, since the most usual time to experience nausea or to vomit is when you first awaken. Unfortunately, this term is not accurate since the symptoms can occur at any time of day.

Certain foods and odors, even familiar ones, can cause nausea and vomiting. Some pregnant women have difficulty cooking specific foods. Some women have the fortunate problem of becoming nauseated by the smell of smoke and so stop smoking early in pregnancy. A variety of reasons for nausea and vomiting have been proposed, but no one really knows why they occur. In the past, they were said to be psychosomatic, indicating perhaps ambivalence toward, or even aversion to, pregnancy, intercourse, or the baby’s father. In some studies, a placebo (or pretend pill) alleviated symptoms, which could be construed as supporting a psychological cause for their occurrence. Other studies, however, found women without nausea and vomiting to be more prone to psychological difficulties during pregnancy and after birth. Another possible reason for nausea and vomiting is hormonal changes, a theory supported by the fact that women on birth control pills, which contain the hormones of pregnancy (estrogen and progesterone), also frequently experience these symptoms.

The woman who vomits during the early months of pregnancy may notice that what she vomits is flecked or streaked with blood. This generally is not a cause for concern, as repeated vomiting may rupture a tiny blood vessel in the throat or esophagus. Such a small vessel clots quickly and heals spontaneously. You should notify your physician or midwife if you notice more than a minute amount of blood in the vomit or if it occurs more than once. Many instances are recorded of particularly suggestible husbands who vomit with their pregnant wives; there are even cases in which the husband vomited though his wife did not. In general, nausea and vomiting subside by 10 to 12 weeks of pregnancy, but may persist. If severe or prolonged, the vomiting may be a pregnancy complication called hyperemesis gravidarum.

Changes in Appetite

Newly pregnant women may notice a temporary decrease in appetite, and ordinary amounts of food may lead to fullness and bloatedness. Women often naturally find themselves ignoring scheduled mealtimes and instead eat frequent small meals-an excellent way to eat during pregnancy. It’s not harmful to the fetus to reduce your food intake in the first trimester, although you should take multivitamins that contain folic acid. If you experience nausea, however, try to avoid going for long periods of time without food. If your stomach is empty, you are more likely to become nauseated-and even to vomit-when you do eat. Of course, eating frequently to avoid nausea may mean that you may gain more than the few pounds usually gained in the first few months of pregnancy.

Some pregnant women develop a craving for one particular food almost to the exclusion of anything else. Earlier obstetrical texts gave more space and emphasis to what they termed pica, or cravings for unusual foods or nonfood substances, than newer texts. But the condition remains a relatively common one. Unquestionably diets are more diversified and better balanced today, and the opportunity to obtain milk, fruits, and vegetables at all seasons of the year is greater. Nonetheless, some women still describe such cravings during pregnancy .

Fatigue and Sleepiness

In many women one of the early symptoms of pregnancy is an unusual degree of sleepiness. The reason for this is unknown. The fatigue generally disappears after the end of the first 3 months, or trimester, of pregnancy, usually to recur near term.

Frequent Urination

Sometimes frequency of urination begins as early as the first day of a missed period. This is caused by pressure on the urinary bladder from the growing uterus. Urinary frequency disappears about the twelfth week, as the uterus grows out of the pelvis, relieving the bladder pressure. It often recurs a few weeks before delivery, when the baby’s head drops into the pelvis, again creating bladder pressure.