First Pregnancy Symptom Trimester

Pregnancy is the carrying of one or more offspring, known as a fetus or embryo, inside the body of a female humans. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets). Human pregnancy is the most studied of all mammalian pregnancies and obstetrics is the medical field that studies and treats pregnant patients.

Childbirth usually occurs about 38 weeks from fertilization, i.e. approximately 40 weeks from the start of the last menstruation. Thus, pregnancy lasts about nine months, although the exact definition of the English word “pregnancy” is a subject of controversy.

One scientific term for the state of pregnancy is gravid , and a pregnant female is sometimes referred to as a gravida . Both words are rarely used in common speech. The term embryo is used to describe the developing human during the initial weeks, and the term fetus is used from about two months of development until birth. A woman who is pregnant for the first time is known medically as a primigravida or "gravida 1", while a woman who has never been pregnant is known as "gravida 0". Similarly, the terms "para 0", "para 1" and so on are used for the number of times a woman has given birth.

In many societies' medical and legal definitions, human pregnancy is somewhat arbitrarily divided into three trimester periods, as a means to simplify reference to the different stages of prenatal development. The first trimester carries the highest risk of miscarriage (natural death of embryo or fetus). During the second trimester, the development of the fetus can be more easily monitored and diagnosed. The beginning of the third trimester often approximates the point of viability, or the ability of the fetus to survive, with or without medical help, outside of the uterus.

Classification

Characteristics

Before pregnancy begins, a female oocyte (egg) must join with a spermatozoon in a process referred to in medicine as "fertilization", or commonly known as "conception". Fertilization usually occurs through the act of sexual intercourse, in which a spermatozoon penetrates and fertilizes an egg. However, the advent of artificial insemination has made it possible for women to become pregnant if pre-existing medical conditions in either the woman or the man make fertilization through sexual intercourse difficult, or if a woman chooses to become pregnant without a male partner. Though pregnancy begins at implantation, it is often convenient to date from the first day of a woman's last menstrual period, sometimes abbreviated "LMP". This is used to calculate the expected date of delivery.

Traditionally a human pregnancy is considered to last approximately 40 weeks (280 days) from the LMP, or 38 weeks (266 days) from the date of fertilization. The 38 weeks of gestation is 10 lunar months, i.e. 27.3 days/lunar-month x 10 = 273 days. In the more familiar Gregorian calendar, the 40 weeks dating from the LMP is equivalent to a little more than nine months and six days. This forms the basis of Naegele's rule of approximating the expected date of delivery, although improvements to Naegele's rule have been suggested. A pregnancy is considered to have reached term between 37 and 43 weeks from the beginning of the last menstruation. Babies born before the 37 week mark are considered premature, while babies born after the 43 week mark are considered postmature.

Though these are the averages, the actual length of pregnancy depends on various factors. For example, the first pregnancy tends to last longer than subsequent pregnancies. Fewer than 10% of births occur on the due date; 50% of births are within a week of the due date, and almost 90% within two weeks. The due date is typically calculated as 40 weeks from the last menstrual period.

An accurate date of fertilization is important, because it is used in calculating the results of various prenatal tests (for example, in the triple test). A decision may be made to induce labor if a fetus is perceived to be overdue. Due dates are only a rough estimate, and the process of accurately dating a pregnancy is complicated by the fact that not all women have 28 day menstrual cycles, or ovulate on the 14th day following their last menstrual period.

The expected date of delivery may also be calculated from sonogram measurement of the fetus. This method is slightly more accurate than methods based on LMP. Confinement, the beginning of labor, begins on the day predicted by LMP 3.6% of the time and on the day predicted by sonography 4.3% of the time.

Medical signs

A number of medical signs are associated with pregnancy.

Early signs

These signs typically appear, if at all, within the first few weeks after conception. Although not all of these signs are universally present, nor are all of them diagnostic by themselves, taken together they may be useful to make a presumptive diagnosis of pregnancy.

  • Presence of human chorionic gonadotropin (hCG) in the blood and urine, detectable by laboratory or home testing; this is the most reliable early sign of pregnancy
  • Missed menstrual period
  • Implantation bleeding, light spotting that occurs at implantation of the embryo in the uterus, in the third or fourth week after LMP
  • Increased basal body temperature sustained for over two weeks after ovulation
  • Chadwick's sign, a darkening of the cervix, vagina, and vulva
  • Goodell's sign, a softening of the vaginal portion of the cervix
  • Hegar's sign, a softening of the cervical isthmus

Later signs

  • Linea nigra, a darkening of the skin in a vertical line on the abdomen, caused by hyperpigmentation resulting from hormonal changes; it usually appears around the middle of pregnancy
  • Steadily increasing abdominal swelling, the most visible sign of pregnancy

Diagnosis

Main article: Obstetrics

The beginning of pregnancy may be detected in a number of ways, including various pregnancy tests which detect hormones generated by the newly-formed placenta. Clinical blood and urine tests can detect pregnancy soon after implantation, which is as early as 6-8 days after fertilization. Home pregnancy tests are personal urine tests, which normally cannot detect a pregnancy until at least 12-15 days after fertilization. Both clinical and home tests can only detect the state of pregnancy, and cannot detect its age.

In the post-implantation phase, the blastocyst secretes a hormone named human chorionic gonadotropin which in turn, stimulates the corpus luteum in the woman's ovary to continue producing progesterone. This acts to maintain the lining of the uterus so that the embryo will continue to be nourished. The glands in the lining of the uterus will swell in response to the blastocyst, and capillaries will be stimulated to grow in that region. This allows the blastocyst to receive vital nutrients from the woman.

An early sonograph can determine the age of the pregnancy fairly accurately. In practice, doctors typically express the age of a pregnancy (i.e. an "age" for an embryo) in terms of "menstrual date" based on the first day of a woman's last menstrual period, as the woman reports it. Unless a woman's recent sexual activity has been limited, the exact date of fertilization is unknown. Absent symptoms such as morning sickness, often the only visible sign of a pregnancy is an interruption of her normal monthly menstruation cycle, (i.e. a "late period"). Hence, the "menstrual date" is simply a common educated estimate for the age of a fetus, which is an average of two weeks later than the first day of the woman's last menstrual period. The term "conception date" may sometimes be used when that date is more certain, though even medical professionals can be imprecise with their use of the two distinct terms. The due date can be calculated by using Naegele's rule.

Diagnostic criteria are: Women who have menstrual cycles and are sexually active, a period delayed by a few days or weeks is suggestive of pregnancy; elevated B-hcG to around 100,000 mIU/mL by 10 weeks of gestation.

Screening

The early stages of pregnancy are often discovered by using a pregnancy test, as soon as 48 hours after fertilization using sophisticated testing methods, but not until six to twelve days after fertilization using more typical methods. Pregnancy tests typically detect the presence of human chorionic gonadotropin.

Pathophysiology

Pregnancy is typically broken into three periods, or trimesters, each of about three months. While there are no hard and fast rules, these distinctions are useful in describing the changes that take place over time.

First trimester

Traditionally, doctors have measured pregnancy from a number of convenient points, including the day of last menstruation, ovulation, fertilization, implantation and chemical detection. In medicine, pregnancy is often defined as beginning when the developing embryo becomes implanted into the endometrial lining of a woman's uterus. In some cases where complications may have arisen, the fertilized egg might implant itself in the fallopian tubes or the cervix, causing an ectopic pregnancy. Most pregnant women do not have any specific signs or symptoms of implantation, alt

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