How to know early if you are pregnant or not ?  

Being pregnant is one of the beautiful feeling a women has on her life. The journey of motherhood starts with pregnancy. Here we discuss the ways to know pregnancy state.

What is pregnancy?

Pregnancy is the time during which offspring develops within uterus. It occurs when an ovum is fertilized by a sperm, grows inside uterus, and develops into a baby.

Reproductive period: The reproductive period of a women usually begins at menarche and ends in menopause. It usually extends from 13 to 45 years.

Duration of pregnancy: The duration of pregnancy is calculated from first day of last menstrual period, 9 calendar months & 7 days or 280 days or 40 weeks.

What are the signs and symptoms of pregnancy?

First trimester (First 12 weeks)

Subjective symptoms in early pregnancy are:

Missed period (Amenorrhea) during reproductive period in a healthy individual with previous normal menstrual periods is likely due to pregnancy.

Morning sickness (Nausea & vomiting): It is inconsistently present more often in first pregnancy than in subsequent pregnancy. It appears soon following missed period & rarely lasts beyond 16 weeks.

Increased frequency of micturition: During 8^th-12^th week frequency of micturition increases.

Breast discomfort: In early 6^th-8^th week especially in first time pregnant women, breast discomfort in form of feeling of fullness & pricking sensation is present.

Fatigue: May occur in early pregnancy.

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Objective signs present in early pregnancy are:

Breast changes: More evident in first time pregnant women, there is enlargement with vascular engorgement is present between 6 & 8 weeks.

Abdominal changes: Uterus may be felt per abdomen after 12 weeks, but before 12 week remains as a pelvic organ.

Vaginal signs: Softened vaginal wall, a copious, non-irritating mucoid secretion at 6^th week and increased pulsation felt through lateral fornices at 8th week.

Cervical signs: Cervix becomes soft.

Uterine signs: Change in shape, size and consistency of uterus.

Laboratory test: Urine pregnancy test can detect pregnancy in couple of weeks. A simple kit can be brought from the pharmacy and can be done by self at home. It detetcs the color change in kit with control provided.

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Ultrasonography: Ultrasound of the abdomen confirms the pregnancy after four weeks. It detects the presence of fetus in the uterus and cardiac pulsation can be detected that suggests the live fetus.

Second trimester (13-28 weeks)

Subjective symptoms are: The subjective symptoms such as nausea, vomiting & frequency of micturition subsides but amenorrhea persists. The new features appearing are:

Quickening (Feeling of life): Perception of active fetal movements, felt about at 18^th week (About 2 weeks earlier in multipara)

Progressive enlargement of lower abdomen due to growing uterus.

Other Findings:

Chloasma: Pigmentation on forehead & cheek appears at 24^th week.

Breast changes: Breasts are more enlarged with prominent Montgomery’s tubercle & secondary areola specially demarcated in first time pregnant women usually appears at 20^th week. Colostrum, the early breast milk becomes thick & yellowish by 16^th week. Variable degree of striae may be visible with advancing weeks.

On abdomen linear nigra (Linear pigmented zone) and linea striae (stretch marks of pregnancy) are seen. The uterus feels soft & elastic, fetal parts can be palpated and active fetal movements can be felt. Your doctor can hear fetal heart sound (Most conclusive clinical sign) between 18^th to 20^th week.

Third trimester (29-40 weeks)

Subjective symptoms are:

• Amenorrhea persists.
• Progressive enlargement of abdomen.
• Frequency of micturition reappears.
• A sense of relief of pressure symptoms (At about 38^th week especially in first time pregnant women) 
• More pronounced fetal movements.

Signs:

• Prominent cutaneous signs with increased pigmentation &striae.
• Shape of uterus changes from cylindrical to spherical beyond 36^th week.
• Fundal height: If head is floating, it is 32^nd week of pregnancy & if head engaged, it is 40^th week of pregnancy.
• Symphysis fundal height: After 24^th week, SFH corresponds to number of weeks up to 36^th weeks.
• Fetal movements easily felt.
• Fetal heart sound distinctly heard.

When to see doctor if you think you are pregnant?

Every pregnant women should be under regular and adequate antenatal care. You should visit doctor if your think you are pregnant or urine pregnancy test is positive. As per WHO recommendation, at least 4 antenatal visits; 1st in around 16th weeks, 2nd between 24-28 weeks, 3rd visit at 32 weeks and 4th at 36 weeks recommended.