Diagnosis of pregnancy and knowledge of normal ﬁndings associated with early pregnancy are common issues in the medical care of reproductive-
The diagnosis of early pregnancy is based primarily upon laboratory assessment of human chorionic gonadotropin (HCG) in urine or blood. History
and physical examination are not highly sensitive methods for early diagnosis, but knowledge of the characteristic findings of a normal pregnancy
can be helpful in alerting the clinician to the possibility of an abnormal pregnancy, such as ectopic pregnancy or the presence of coexistent
The most common signs and symptoms of early pregnancy are:
Additional signs and symptoms include:
WHEN TO BE CONCERNED ABOUT PREGNANCY SYMPTOMS
Vaginal bleeding — Bleeding in early pregnancy that is heavier than spotting or accompanied by any pain may represent an ectopic pregnancy or
impending miscarriage however any amount of bleeding is worrisome.
Nausea and vomiting — The onset of nausea and vomiting after about 10 weeks of gestation should prompt an evaluation, because this is after
the typical period expected for onset of pregnancy-related nausea and vomiting. A cause other than pregnancy should be considered if nausea and vomiting are accompanied by pain, fever, vertigo, diarrhea, headache or abdominal distension.
Hyperemesis gravidarum is considered the severe end of the spectrum of nausea and vomiting of pregnancy, and is commonly defined as
persistent Vomiting accompanied by weight loss exceeding 5 percent or prepregnancy body weight and ketonuria unrelated to other causes.
Urinary frequency — Cystitis or an upper urinary tract infection should be suspected if pregnancy-related urinary frequency is accompanied by
dysuria, hematuria, pyuria, fever, or ﬂank pain.
Dyspnea — Pregnancy-related dyspnea is usually mild, of gradual onset, and not associated with other pulmonary signs or symptoms (eg, cough,
wheezing, pleurisy, blood in the cough,) or systemic findings (eg, fever or increase in basal heart rate by more than 15 to 20 beats/min).
Lightheadedness — Pregnancy-related Iightheadedness typically occurs when the woman has been standing, especially in a warm environment. It
should resolve when she lies on her left side.
Pelvic discomfort — The round ligaments begin near the uterine cornua, pass through the abdominal inguinal ring and along the inguinal canal,
and end in the labia majora. Pain in the location of the round ligaments has been termed “round ligament pain;” it is common and a diagnosis of
exclusion. The pain is typically on the right side of the abdomen/pelvis and often occurs upon waking, suddenly rolling over in bed, or other vigorous
activity. The pain is believed to be caused by irritation of nearby nerve fibers or spasm of the ligament; rarely. it may be due to varicosities, myomas,
or endometriosis associated with the ligament. A change in position may alleviate the pain, but no treatment is necessary, as the pain is usually mild
Adnexal disease (eg. ectopic pregnancy, ruptured ovarian cyst, ovarian torsion) should be excluded when the pain is moderate or severe,
persistent or progressive, or accompanied by vaginal bleeding or peritoneal signs.
Midline pelvic pain and vaginal bleeding are the cardinal signs of impending or ongoing spontaneousmiscarriage. After 20 weeks of gestation,
preterm labor and abruptio placentae should be excluded in women with these symptoms.
Right lower-quadrant pain is a common symptom of appendicitis, which should be excluded. Although the location of the appendix migrates a few
centimeters cephaiad as the uterus enlarges. the most common symptom of appendicitis
Chest pain — Chest pain not due to gastrointestinal reﬂux is not a normal finding in pregnancy.