This document discusses signs and symptoms of pregnancy and minor disorders of pregnancy. It begins by outlining the objectives of reviewing female hormonal cycles, signs and symptoms of pregnancy, and minor pregnancy disorders and their management. The document then discusses the signs and symptoms of pregnancy, categorizing them as possible, probable, or positive signs. Finally, it reviews some common minor disorders during pregnancy, including nausea/vomiting, heartburn, excessive salivation, pica, constipation, and backache, and provides advice on managing these conditions.

1. Signs and Symptoms & Minor Disorders of Pregnancy
Jacktan Josephat Ruhighira
MSc Physiology, PhD (C)

2. Session Objectives
• Summarize the physiology of ovarian and menstrual
cycles
• Explain the signs and symptoms of pregnancy
• Explain the minor disorders of pregnancy and their
management
By the end of this session, everyone should be able to

3. Introduction
• Those felt by woman (symptoms)
• Those noticeable by examiner (signs)
• Allow woman to start presume herself
to be pregnant, and the examiner query
and diagnose pregnancy
Pregnancy brings physiological changes
• Are common to many pregnant woman
• A midwife/obstetrician should be able
diagnose, monitor and manage these
disorder
• Sometimes they may progress into a
serious condition
Changes tends to cause minor disorders

4. Let’s review the female monthly
cycles before going any further

5. The female hormonal system-HPO Axis
3 levels of command
• Secrete GnRH
Hypothalamus
• Respond to hypothalamic GnRH
• Secrete FSH and LH
Anterior pituitary gland
• Respond to pituitary sex
hormones
• Secrete estrogen and
progesterone
The ovaries

7. Ovarian Cycle
• 3 phases
− Follicular: the graafian
follicle undergoes
development to form
mature ova while
producing estrogen
− Ovulation: the mature
ovum swells and
detach from the ovary
− Luteal: the cells
remaining after release
of ovum become
yellow estrogen and
progesterone secreting
tissue called corpus
luteum

8. Regulation of the Ovarian Cycle
• Positive:
Estrogen
alone
• Negative:
Estrogen +
Progesteron
Both positive
and negative
feedback
mechanisms

9. Ovarian Hormones
• 3 estrogens are significant : β-
estradiol which is most important,
estrone, and estriol
• The most important progestins is
progesterone
Estrogens and progestins
• Synthesized first as progesterone
and androgens then converted to
estrogens by aromatase enzyme
• During the luteal phase,
progesterone formed is too much
for all of it to be converted
Synthesized from cholesterol

10. Estrogen Effects: Female Sex Characteristics
• Growth of the tissues of the sex
organs and other tissues related to
reproduction
Cause cellular proliferation
• From a cuboidal into a stratified
type, which is more resistant to
trauma and infection
Change the vaginal epithelium
• Cause proliferation of the
endometrial stroma and
development glands
Increase size of the uterus
Initiate growth of the breast glands

11. • With deposition of fat
Enlarge external genitalia
• Cause texture that is soft and
smooth
• Increase warmth of the skin
• More bleeding from skin cut is
observed in than in men
Increase skin vascularity
• Estrogen has no great affect
• Growth of hair on pubis and
axilla is by increased adrenal
androgens after puberty cause
On hair distribution
Estrogen Effects……….

12. Effects of Estrogen on Metabolism and ECF Volume
• Increase but not as much as
testosterone
Whole-body metabolic rate
• stimulate bone growth
Inhibit osteoclastic activity
• Increase protein deposition slightly
• Increase deposition of fats in the
subcutaneous tissues
• Body fat % is greater in female
Affect body composition
Cause slight renal sodium
and water retention

13. Physiological Effects of Progesterone
• In the uterine endometrium
• The fallopian tubes mucosa
• Development of the lobules and
alveoli of the breasts to become
secretory
Promote secretory changes
Inhibit uterine contractions
Increase body temperature
• Increase respiration depth and
tidal volume
Stimulate respiratory center
• By salt and water retention
Increase blood volume

14. Uterine Cycle
• By which
endometrial
• Prepare to receive
and nourish
pregnancy and
desquamated if
pregnancy does not
occur
The monthly process
• Menstruation,
follicular, secretory
Three phases:

15. • The endometrial tissues are desquamated
and expelled as menses
• When pregnancy does not occur the corpus
luteum degenerates hence progesterone
secretion to maintain endometrial wall ceases
Menstrual: 1st to 3-5th day of cycle
• The endometrial wall grows, stroma and
glands increase under the influence of
estrogen from developing follicle
Proliferation: 3-14th day of cycle
• Under the influence of progesterone from
corpus luteum which maintains the
endometrial wall
• The endometrial blood supply increases
• Glands secretes nutrient rich fluid which
nourishes embryo if pregnancy occurs
Secretory phase: 14th day
Uterine
Cycle……

16. Relationship between Ovarian and Uterine Cycles

17. Signs and Symptoms of Pregnancy

18. Signs and Symptoms of Pregnancy
Classified into 3 groups
• These are the changes felt by the
mother
Possible/Presumptive Signs
• Those changes observed by an
examiner but could be caused by
a condition other than pregnancy
Probable signs
• Those signs that can be attributed
only by the presence of fetus
Positive signs

19. Possible (Presumptive) Signs
• Enlargement of breasts
• Darkening of areola, unreliable in
multigravida, pigmentation may persist
after delivery
Breast changes 3 – 4 weeks +
• Absence of menstruation
• In most cases it is a sign of pregnancy,
• Can be other causes of amenorrhea such
as emotional disturbances, hormonal
imbalance, pseudocyesis (false
pregnancy) sometimes slight bleeding
may occur during implantation
Amenorrhoea 4 weeks +

20. • Occurs in 50% of pregnant women
• But there other causes of vomiting
e.g. gastrointestinal disorders,
pyrexia illness
Morning sickness 4 – 14 weeks
• It includes frequency of micturition
• Can be other causes e.g. urinary
tract infection, pelvic tumor
Bladder irritability 6 – 12 weeks
• Fetal movements felt by the mother
• The woman may imagine fetal
movements
Quickening 16 – 20 weeks +

21. Probable Signs
• In blood: 9 – 10 days
• In urine: 14 days
• It can also be found in hydatidiform mole
and choriocarcinoma
Presence of HCG
• Hegar’s sign 6 – 12 weeks
• When two fingers are inserted into the
anterior fornix and the other hand is
inserted behind the uterus abdominally
• The fingers of both hands almost meet
because of the softness of the isthmus
Softened isthmus

22. • Chadwick’s sign 8 wks +
• Violet blue discoloration of the
vaginal mucosa due to pelvic
congestion
• But may also be present in pelvic
tumor
Blue vagina
• Osiender’s sign) 8 wks +
• Increased vaginal pulsation
mirroring maternal heart rate is
due to pelvic congestion
Pulsation of the fornices

23. • Grows as fetus grow
• But may grow due to other
reasons e.g. fibroids
Uterine growth 8 weeks +
• Includes skin pigmentation,
linea nigra, striae gravidarum
• Other factors may cause
increase of melanin e.g. post-
inflamation
Changes in skin pigmentation

24. • Soft blowing sound felt on
auscultation, due to increased blood
flow to the uterus at 12 – 16 wks
• Can also occur in uterine tumor
Uterine soufflé
• Painless uterine contractions are
palpable at 16 wks
• But can be caused by thyroid
disorders, polycystic ovarian
syndrome etc
Braxton Hicks contractions
• The fetus can be balloted between
two hands at 16 – 28 wks
Ballottement of the fetus

25. Positive Signs of Pregnancy
• Ultrasound: 6 wks +
• Fetal scope: 20 – 24 wks +
Hearing fetal heart sounds
• ultrasound: 6 wks +
• X –ray: 16 wks
Visualization of fetus by
Fetal parts palpated: 24+ wks
• Palpable: 22 wks +
• Visible: Late pregnancy
Fetal movements

27. Minor Disorders during Pregnancy

28. Minor Disorders
• Midwife has to educate women on the changes during
pregnancy to alleviate unnecessary anxiety
• Also has to provide practical advice to ease the situation as
far as possible
Disorders which are not life threatening
• The role of a midwife is to be aware of any developing
complication and manage or refer appropriately
But may develop into a serious complication
• Hormonal changes, accommodation changes, metabolic
changes and postural changes.
Causes;
Every system of the body is affected by pregnancy

29. Digestive System: Nausea and Vomiting
• Due to hormonal influences, HCG, oestrogen and progesterone
• The smell of food may cause the mother to retch
• Not confirmed to early morning, can occur at any time of the day
It occurs between 4 and 16 weeks
• Explain the probable reasons and encourage the woman to be
positive
• Advise eating small frequent meals instead of 3 large meals and
• Advise avoiding bothering smell or food types
• Advise eating snacks at bed time and before raising to prevent
hypoglycemia which also can cause nausea and vomiting
• Rule out other conditions unrelated to pregnancy which cause
vomiting
Management

30. Digestive System: Heart burn
• Progesterone relaxes the cardiac sphincter of the stomach
and allows reflux of gastric content into the esophagus
• More bothersome at 30 – 40 weeks
Burning sensation in the mediastinum region
• Avoid bending over when doing house keeping
• Eat frequent small meals which take up less space and are
digested more easily than few large meals
• Sleeping with more pillows than usual
• For persistent heart burn antacids may be prescribed
The advice varies according to the severity

31. Digestive System: Excessive Salivation (Ptyalism)
• May accompany heart burn
It occurs from the 8th week and is
caused by hormones of pregnancy
• Explanation
• Chewing on ice and sugarless gum
• Using minty mouthwash and
toothpaste
• Eating or drinking sour thing e.g.
lemon slice
• Advise to carry container and
tissue to collect and wipe saliva
Management

32. Digestive System: Pica
A woman craves certain foods or non-food substances
• Hormones or metabolic change
Causes
• Rule out if the substance craved is potentially harmful to the
unborn child
• Monitor Iron status along with other vitamins and supplement
if indicated
• Replace craved substance with other thing such as sugarless
chewing gum
Management

33. Digestive System: Constipation
• Cause relaxation of GI smooth
muscles and decreased peristalsis of
the gut
Due to progesterone
• Increase water intake, fresh fruits,
vegetables and whole meal food in the
diet
• A glass of water in the morning before
tea or breakfast may activate the gut
and help regular bowel movements.
• Exercises are helpful especially
walking
Management

34. Musculoskeletal System: Backache
• Due to changing of centre of gravity as the fetus grows and which
posture to adopt
• Hormones also softens ligaments
Pain of the back
• Bending knees while keeping back straight when lifting/picking
• Avoid lifting heavy objects
• Wear flat shoes to distribute weight evenly
• Try to balance weight e.g. between two bags or buckets
• Advice the woman on posture, and encourage practice pelvic
exercises
• Reassure the woman that once birth occurs, the ligaments will
return to normal
Management

35. Musculoskeletal System: Cramp
• It may be due to change in
electrolyte status
The cause is unknown
• Foot and leg exercises and
massage
• Raise the foot of the leg about
25cm
• Make gentle leg movement while in
warm bath before going to bed
• Vitamin B complex and calcium
may be used
Management

36. Genito-urinary System: Frequent Micturition
Due to pressure of the growing uterus and fetal
head on the bladder
• The midwife should reassure the mother
• Exclude other causes of bladder irritability
• Don’t hold urine, empty bladder
• Learning forward while urinating to empty bladder fully
• Drink enough water earlier and less just before going to bed
• Avoid caffeine beverages and foods
Management

37. Genito-urinary System: Leucorrhoea
• Due to hormones especially
progesterone
The increased white non-irritant
vaginal discharge
• The midwife should advise the woman
on personal hygiene, wear cotton
underwear and avoid tights, washing
with plain water twice daily
• The midwife should exclude the
possibility of infection
Management

38. Circulatory System: Fainting
• Is due to vasodilatation due to effect
of progesterone
• The woman should avoid long
periods of standing to prevent blood
from pooling in lower extremities
In early pregnancy
• The woman may feel faint when
lying on her back due to the weight
of the uterus on the inferior vena
cava
• Turning the woman on her side
brings a rapid recovery
In late pregnancy

39. Circulatory System: Varicosities

40. • Result in sluggish circulation, the valves of dilated veins become
inefficient
• Varicose veins may occur in the legs, vulva and anus
(haemorrhoids)
• Mothers at more risk: with family history of varicose veins, work
demanding long standing
Progesterone relaxes smooth muscles of the veins
• Exercises of calf muscles
• In early pregnancy, resting with legs raised to drain the veins
• Support tights increase comfort
• Avoidance of constipation
• In vulva varicosities, a sanitary pad may give support and provide
comfort
• Be aware of the risk of haemorrhage from ruptured vein during
delivery.
Management

41. Nervous System: Carpal Tunnel Syndrome
• Caused by fluid retention which
creates oedema and pressure on
the median nerve
The numbness and ‘pins and
needles’ in fingers and hand
• Wearing a splint at night and
resting the hand on pillows
• The condition usually resolves
spontaneously after delivery
Management

42. Nervous System: Insomnia
• This may be caused by nocturnal frequency and difficult in getting
comfortable due to the growing fetus
• Increased blood supply to the uterus on lying down often causes the
baby to move a lot
• May be overcome by going to bed earlier
Lack of sleep
• Discuss with the mother about the common fears of pregnancy and give
reassurance
• In late pregnancy advice the woman to rest in the morning or afternoon
when sleep often comes easily
Increased anxiety
• Due to hormonal changes towards the end of pregnancy also
• Give psychological support
Periods of depression

43. Skin
• Abdomen and breasts, occasionally it is generalized over the
whole body
• Due to hormones of pregnancy and increased billirubin levels
Itching of the skin
• Local application e.g. Calamine lotion may give comfort
• An antihistamine such as piriton may be prescribed
• Wear non irritant cloths next to the skin
• If the woman complains of vulval irritation; infection such as thrush
and glycosuria due to diabetes, should be excluded and then
advice on cotton underwear and adequate washing with soap and
water
Management of itching includes
• Skin changes should be diminished as soon as the baby is born
Reassure the woman

44. References
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