Welcome to antepartum care. In this module, we're going to discuss what happens during the
very first antepartum visit. Now, what are the things that's really important when someone
says "I think I'm pregnant" is determining how likely they might really be pregnant. And we
use something called signs of pregnancy and we grouped certain symptoms to make that
determination. Let's talk about what those are. The first one is a presumptive sign. So
presumptive signs are usually subjective complaints that the patient may have. They may
say "You know I haven't had my period in a few weeks" or they may complain about breast
tenderness, feeling really tired, having to use the restroom fairly often, maybe nausea and
vomiting might be something that they tell you about quickening which refers to the first time
the patient perceives fetal movement or they may say, "You know what, I have a little baby
bump here and I think that I might be pregnant." Those are all subjective complaints and we
presume when someone says that, that they might be pregnant but it's not always the case.
Now let's move a little bit further on the assurance radar to probable signs. Probable signs
are going to be objective symptoms that we actually can confirm through physical assessment
that may say "Yup, you might be pregnant." That includes outlining the fetus. So if the
examiner can feel the shape of the baby, that's a good possibility that there is a baby in
there, but it could also be a tumor so it's not 100%. A pregnancy test may also be another
way that we can try to confirm pregnancy. But certain types of tumors and cancers also give
off hCG, which is the hormone we check for so that is also not 100%. Balloting the fetus just
refers to sort of pushing on it. When you push on something that's ballotable, if you press it
it will bounce back up against your hand. So again, this implies some things in the uterus but it
may not be a baby. So, not 100%. Braxton Hicks contractions are contractions that the
patient perceives, they don't change the cervix so it's not labor but they can definitely feel
their uterus contracting. That's a little bit more of a sign, but still probable. The last 3 signs
on the probable list we're going to look at in more detail in just a second; Goodell, Hegar, and
Chadwick's. So hold that in your thinking cap for just a minute while we talk about positive
signs of pregnancy. So positive signs means they're pregnant, no doubt, 100%, can't be
anything else, not an alien, not a tumor, nothing. So, positive signs include being able to hear
fetal heart tones. If you're able to recognize that there is a heartbeat in there, it's got to be
a baby. Also, if we use an ultrasound to actually look and see, you may have seen pictures of
wonderful baby pictures and you can tell the baby is sucking its fingers or doing something
else. When you can see the baby, you know there is a baby there. Or, if the examiner can
actually feel the shape of the fetus and the baby then kicks them, punches them, it does
something like that then it's a baby. Because if it's a tumor, it usually doesn't kick back. So
those are going to be positive signs. So we want to make sure we can break those signs into
those groups so we can confirm 100% that someone is pregnant. Now I told you I would talk
about those probable signs in a little more detail so here we go. So, Hegar's refers to the
softening of the uterus. Think about the fact that all of these blood flow is now moving into
the uterus and it's going to make the tissue much softer. So during a bimanual exam, the
examiner can actually feel that the uterus is a little bit softer than it usually is. That's called
Hegar sign. Now when we talk about the softness of the cervix itself, that's called Goodell
sign. So it's good and soft. That's how I remember. And then Chadwick's refers to the color
of the cervix. So because of all that increased blood flow, the cervix actually begins to look
kind of blue. So, C for color, C for Chadwick's meaning that the cervix has now taken on a
sort of blue tinge. That lets us know possibly this is a pregnant cervix.