i) No menses (Amenorrhoea):

This is actually physiological amenorrhoea. It lasts throughout pregnancy. It is due to high levels of oestrogen, progesterone and human chorionic gonadotrophin. There is continued build up of the endometrium to support the developing pregnancy. This build up also averts menses.

2) Breast Tenderness and/or Tingling

This usually occurs during the first trimester of pregnancy. The hormones of pregnancy stimulates the growth of the breast tissue. Women may also experience upper backache from the increased weight of the breasts.During pregnancy there is also increased blood flow throughout the breasts and delicate veins become visible beneath the skin.

3)Weight Loss

This may occur in the first trimester of pregnancy if the woman experiences morning sickness (nausea and vomiting). She may not be eating normally in early pregnancy due to the nausea and vomiting.

4) Nausea with or without vomiting

This is common in the first trimester. This is probably due to hormonal changes of pregnancy leading to slowed peristalsis throughout the gastrointestinal tract and changes in taste and smell. The growing uterus and emotional factors may also contribute to the nausea and vomiting. Women may have a moderate (2-5 lb) weight loss in the first trimester.

5) Groin/Lower Abdominal Pain

This is common in the 2nd trimester (14-20 weeks). This is due to rapid uterine growth in the early part of the second trimester which causes tension and stretching of the round ligaments. This causes spasm with sudden movement or change of position.

6) Increased Frequency of Passing Urine:

This occurs in the 1st and 3rd trimesters. This is probably due to the increased blood volume and increased filtration rate in pregnancy.This is compounded by less space for the bladder from pressure of the growing uterus (first trimester) or from the descent of the fetal head (third trimester).

7)Tiredness (Fatigue)

Common in the 1st and 3rd trimesters. This is due to changes in energy requirement.

Contributory factors include sedative effect of progesterone, weight gain,changes in mechanics of movement and sleep disturbances.

8) Edema (swelling of the legs-due to fluids)

This usually occurs in the third trimester. Factors that contribute to edema in pregnancy include obstruction of lymphatic flow, increased venous pressure in the legs and reduced plasma colloid osmotic pressure.

9) Backache

This may occur anytime during pregnancy. The minor lordosis required to balance the growing uterus and the hormonally induced relaxation of joints and ligaments may result in lower backache

10)Leukorrhea (increased milky white discharge from the vagina)

This may occur throughout pregnancy. This asymptomatic milky white vaginal discharge results from increased secretions from the cervix and vaginal epithelium due to the hormones and vasocongestion of pregnancy.

11) Heartburn and Constipation

This may also occur anytime during pregnancy and is due to the relaxation of the lower oesophageal sphincter which allows the contents of the stomach to reach the lower oesophagus. There is also decreased gastrointestinal motility due to the hormones of pregnancy which may cause constipation. Existing haemorrhoids may also be aggravated by the constipation.

References:

Pages 817 to 823. Chapter 19. The Pregnant Woman. Bates Guide to Physical Examination and History Taking.

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