Maternal & Newborn · Topic 40 of 58
Signs of Pregnancy (Presumptive, Probable, Positive)
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Signs of Pregnancy (Presumptive, Probable, Positive)
The three tiers sort a finding by who finds it and whether anything else could cause it. Only what comes from the fetus is positive; a positive pregnancy test is only probable.
Presumptive signs
What the client reports — could have other causes
Probable signs
What the examiner finds — could have other causes
Typical onset: Goodell sign about 4–6 weeks; Chadwick and Hegar signs about 6–8 weeks. Texts differ on skin hyperpigmentation and uterine enlargement: presumptive in some, probable in others. Palpating the fetal outline is probable. Addison's disease can also cause hyperpigmentation. Some texts class a positive home test as presumptive and a positive blood test as probable; either way, an hCG test is never a positive sign.
Positive signs
These can only come from the fetus
Who felt the movement?
The same movement, a different tier
| Felt by the client | Felt by the examiner | |
|---|---|---|
| Called | Quickening | Fetal movement felt by the examiner |
| Tier | Presumptive | Positive |
| Usual timing | About 16–20 weeks | Usually after 20 weeks |
| Other causes | Can be peristalsis or flatus | None: it can only come from the fetus |
Findings that can mislead
A positive test is only probable — hCG has other sources
A positive hCG does not show where the pregnancy is or that it is viable; ultrasound does. hCG that fails to rise or falls suggests ectopic pregnancy or miscarriage. In early pregnancy hCG often about doubles every 48 hours; a smaller rise does not alone mean a problem, so serial levels are read with ultrasound. Fertility medicines can cause a false-positive test, and pituitary disease can also make the result inaccurate.
Nursing priorities
Teach your patient
hCG is made by trophoblast tissue and appears in blood and urine as early as 10 days after conception. A blood test finds very small amounts of hCG and can show pregnancy before a missed period; a urine test is cheaper and faster.
Positive signs can only come from the fetus: heart tones, the fetus on ultrasound, movement the examiner feels. A positive pregnancy test is only probable, because hCG can also come from a molar pregnancy or a tumor.
Sources · Open RN Nursing Health Promotion 9.3: Diagnosing Pregnancy (LibreTexts) · Merck Manual Professional: Evaluation of the Obstetric Patient · FDA: Home Use Tests, Pregnancy · MedlinePlus: Pregnancy Test · MedlinePlus Encyclopedia: Quantitative HCG blood test · MedlinePlus Encyclopedia: Pregnancy test · StatPearls: Human Chorionic Gonadotropin (NCBI Bookshelf) · U.S. Army Medical Department course (Brookside Press): Probable Signs of Pregnancy · Merck Manual Consumer: Ectopic Pregnancy · MedlinePlus: Prenatal Care · Diagnosis and Management of Ectopic Pregnancy (Am Fam Physician, 2014) · Braxton Hicks Contractions (StatPearls) · Follow your facility's protocol for pregnancy testing.
Signs of Pregnancy (Presumptive, Probable, Positive)
The signs of pregnancy are sorted into three tiers: presumptive signs the client reports, probable signs the examiner finds, and positive signs that only the fetus can cause. Presumptive signs include amenorrhea, nausea and vomiting, breast tenderness, urinary frequency, fatigue and quickening, and each could have another cause. Probable signs include Goodell, Chadwick and Hegar signs, uterine enlargement, ballottement, Braxton Hicks contractions and a positive hCG test. A positive pregnancy test is only probable, because hCG can also come from a molar pregnancy or some tumors. Positive signs are fetal heart tones, heard by handheld Doppler from about 10 to 12 weeks, the fetus seen on ultrasound, and fetal movement felt by the examiner. The same movement felt by the client, usually at about 16 to 20 weeks, is only presumptive. For a home test, teach the client to use first-morning urine, that the test is most reliable 1 to 2 weeks after a missed period, and to see a provider soon after a positive result to start prenatal care.
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