28 – SIGNS AND SYMPTOMS OF PREGNANCY
THE signs of pregnancy very considerably in different women, both as to their nature and the periods of their occurrence. The inquiry as to the existence of pregnancy is often one of great importance and anxiety, and we therefore place before the reader the most characteristic signs and symptoms to which this condition gives rise. In estimating the conclusiveness of these signs, reference must be had to their number and importance, the previous condition of the patient any accidental causes which may have been in operation of produce abnormal changes. Only four of the following signs can be considered as certain, and these only when clearly made out; they are-the sounds of the foetal heart, the movements of the child felt by another, fluctuation, and ballottement. The other signs are probable ones; probability, however, almost rising into certainty in some cases and at certain periods of gestation.
1. ABSENCE OF MENSTRUATION – One of the first circumstances which leads a lady to think herself pregnant is the arrest of the usual monthly discharge. If the suppression of the menses occur in a healthy woman, who had before been regular, and who has not been exposed to cold or wet, or any other accidental cause likely to influence the menses, and especially if at the second or third period the menses are still absent, pregnancy may be suspected. This sign will be much more conclusive if there are superadded to it other symptoms indicative of pregnancy, such as those described further on.
But although this is one of the earliest signs of pregnancy, still no certain conclusion can be arrived at from it, in as much as the menstrual function may be suppressed from causes altogether distinct from pregnancy – mountain air, an entire change of habits, a sea voyage, etc.; or conception may occur prior to the establishment of menstruation or immediately after ceasing to nurse, and before the function has had time to recur. Again, the menstrual discharge may be suspended as the result of disease, and conception may take place before the function is re- established.
It therefore follows that, though the absence of menstruation is of considerable value as evidence of pregnancy, it cannot, per se, be regarded as an absolute sign.
2. MORNING SICKNESS – Generally, in from two to six weeks, sometimes immediately after conception, ladies suffer more or less from nausea, and sometimes vomiting, on first taking the erect posture, probably from the uterine vessels being then more congested, and hence termed Morning sickness. Occasionally, these symptoms are so severe and persistent as very seriously to impair the health of the patient; on the other hand, some patients do not experience sickness at all.
In consequence of its intimate nervous connections with all parts of the body, the stomach often acts sympathetically in comparatively trifling derangements. Cerebral excitement, nervous irritation, affections of the bowels, kidneys, liver, etc., are all capable of exciting abnormal action in the stomach resembling that which attends pregnancy. As an isolated sign of pregnancy, therefore, this is one of but limited importance; it may be absent altogether, occur at unusual times, or take unusual forms; but when it is combined with other symptoms described in this chapter, occurs in the usual order of time, and there is no apparent cause for it, such an indigestion, and the tongue is clean, and the appetite and general health continue good in spite of nausea, it furnishes an important link in that chain of evidence which indicates the pregnant condition.
The treatment of this condition is described further on.
3. ENLARGEMENT OF THE BREASTS. – The examination of the breasts furnishes an experienced observer, acquainted with the general anatomy of the glands, with valuable data on which to found an opinion touching the existence of pregnancy. Generally, to about six or eight weeks after conception, often earlier, there occurs a sensation of fulness, with throbbing and tingling pain in the breasts, accompanied by their enlargement. They become larger, firmer, and feel knotty, and after a time a milky fluid may be secreted. But these symptoms cannot alone be relied upon as evidence of pregnancy, since irritation of utero-genital apparatus, suppressed menstruation, uterine tumors, or even, in some females, the appearance of the monthly discharge, may give rise to them. A temporary enlargement, simply consequent on marriage, is sometimes observable, without the occurrence of conception. Enlargement of the breasts may also be due to fatty deposit; but in this case other parts of the body will present evidence of a proportional increase of the fatty material. The true character of the enlargement is easily recognisable by the touch of the experienced finger; that from fatty enlargement is soft and uniform, but that from pregnancy is hard and knotty, and the lobules of the gland may be felt beneath the skin, arranged in a regular manner around the nipple. Enlargement from chronic disease is perhaps less likely to lead to an erroneous conclusion, as one breast only is involved, and that partially
so.
4. DARKENING OF THE AREOLA AROUND THE NIPPLE – In the virgin state the colour of the nipple and areola is usually but a shade deeper than that of the skin generally; but in about six or eight weeks after conception, the delicate pink-coloured circle around the nipples becomes several shades darker, the circle increasing in extent, and in depth of colour, as pregnancy progress. This change is so strongly marked in primiparae, as to afford a good sign of gestation. It is, however, rendered of less general value from the fact that after the first pregnancy the dark colour becomes permanent, and is but little modified by subsequent ones. Concurrently with the altered colour of the areola, the nipples and surrounding integuments become swollen, puffy, and more moist, secreting a fluid which stains the linen; and the veins beneath the skin become more visible. Prominent points or glandular follicles, varying in the number from twelve to twenty, project from the sixteenth to the eighth part of an inch, immediately around the base of the nipple. These changes, which are often well marked, are not, however, always so. The darkening of the areola is less marked in women of light complexion; and something resembling it, as also enlargement of the mammary gland, is said to be present when the uterus is distended from other causes than pregnancy.
Alternations in the size and appearance of the breasts, the two signs just referred to afford to the educated hand and eye of the practitioner valuable evidence; they have also this additional importance, that an examination of them is easily obtainable, and, for various reasons, more readily conceded than one involving the vagina and abdomen.
5 MILK IN THE BREAST – This sign, considered very conclusive of pregnancy, is often unreliable. Women who have borne children sometimes continue to secrete milk for a long time – even for years; in such cases, therefore, this sign is of little value. Milk in the breasts also occurs in other conditions of the system besides pregnancy, and even in females who have never borne children.
6. ENLARGEMENT OF THE ABDOMEN – After impregnation, an increased efflux of blood occurs towards the womb, the tissues of which gradually expand, imparting a feeling of weight, fulness, and sensitiveness in the utero-genital organs.
The gradual enlargement of the uterus furnishes a tolerable accurate guide to the period of pregnancy, by the height which it attains in the abdomen. In about two months, the intestines are somewhat elevated, and by the end of the third month, the enlargement may be perceived; at the fourth month, the womb rises out of the pelvis in the form of a hard round tumor, and then gradually rises, and enlarges the whole abdomen. It reaches the umbilicus (navel) at the sixth months, and is highest at the night, when it reaches the ensiform cartilage, and impedes the descent of the diaphragm; during the last month it sinks a little, probably from some diminution of liquor amnii.
The sensation conveyed to the hand by the pregnant uterus is very different from that of the abdomen distended by fluid, flatus, etc.; the former being firm, elastic, defined; the movements of the foetus may be felt by the practised hand; but in the latter there is an absence of firmness and elasticity, and the tumor is not defined. On reaching the umbilicus, the uterus pushes it forward, so that in about the sixth month it is more prominent than natural, and afterwards it protrudes somewhat from the surrounding skin.
Enlargement of the abdomen, as a sign of pregnancy, is liable to variation; it may be distended by tympanitis 1 (1The Author was recently consulted by a married lady greatly desirous of offspring, in whom abdominal enlargement was so great that she was encouraged to make preparation for labour, the local medical attendant having sanctioned this view of her condition. We diagnosed the enlargement as a simple tympanitis of the abdomen, and prescribed Ignatia. In six days she presented herself with the enlargement wholly gone, and her health in other respects correspondingly improved.) or faecal accumulations in the intestines, or by ovarian dropsy; or the uterus may be enlarged by air, fluid, or hydatids. In many cases the abdomen even becomes flatter at first, from the sinking of the impregnated uterus in the pelvis, attended perhaps with a slight retraction of the navel.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."