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 Signs and symptoms of pregnancy

Signs and symptoms of pregnancy are common, benign conditions that result from the changes to the body that occur during pregnancy.

Pregnancy symptoms may be categorized based on trimester as well as the region of the body affected.

1-Early pregnancy 1.1-Implantation bleeding 1.2-Breast tenderness 1.3-Fatigue 1.4-Nausea and vomiting (morning sickness)

2-Mid and later pregnancy 2.1-Musculoskeletal pain and discomfort 2.2-Fluid imbalance and kidney function 2.3-Gastrointestinal (GI) 2.4-Skin and vasculature changes

Early pregnancy

Many of the early signs of pregnancy will be similar to symptoms that come right before a period and it can be hard to tell the difference.

Implantation bleeding

• Implantation bleeding is light vaginal bleeding in the first 10 – 14 days of pregnancy caused by the normal implantation of the embryo in the uterine wall.

• Implantation bleeding may be confused with a regular period. Heavy vaginal bleeding in the first trimester or bleeding associated with pain, may be a sign of a complication, such as an ectopic pregnancy, that would need to be assessed by a healthcare provider.

Breast tenderness

Hormonal changes in early pregnancy can cause breast swelling and tenderness. Breast tenderness typically improves as the body adjusts to the pregnancy.

Fatigue

Fatigue in the first trimester is common due to changes in hormones.

Nausea and vomiting (morning sickness)

• Although described as "morning sickness," pregnant women can experience this nausea any time of day or night. 

• occurs in 80% of pregnant women.

• Nausea and vomiting in pregnancy are typically mild and self-limited, resolving on their own by the 14th week of pregnancy. 

• changes to diet and emotional support may be the Initial treatment.

• A rare form of severe nausea and vomiting known as hyperemesis gravidarum can occur in 1% of pregnant women and can affect fetal and maternal health.

Mid and later pregnancy

Musculoskeletal pain and discomfort

1-low back pain and pelvic girdle pain

• Pregnancy-related low back pain (PLBP) and pregnancy-related pelvic girdle pain (PGP) are common conditions occurring in an estimated 45% of pregnant women and 25% of postpartum women.

• Pregnancy-related low back pain and pelvic girdle pain can occur together or separately. The pain is often dull, intermittent, worse in the evening, and usually occurs within 30 minutes of activities like walking, standing, or sitting.

• During pregnancy, the enlarged abdomen, and gravid uterus place additional strain on the lumbar muscles and shift the pregnant woman's center of gravity. These postural compensations culminate in an increased load on both the lumbar spinal musculature and the sacroiliac ligaments, manifesting as low back pain and/or pelvic girdle pain.

• Hormonal changes throughout pregnancy also cause an increase in joint laxity further contributing to the development of PLBP and PGP.

• Land or water-based exercise may both prevent and treat lower back and pelvic pain, yet current research in this area is of low quality.

2-Carpal tunnel syndrome

• Carpal tunnel syndrome can occur in up to 70% of pregnant women and typically has a benign course. It manifests as pain, numbness, and tingling in the thumb, index finger, middle finger, and the thumb side of the ring finger. The symptoms of carpal tunnel syndrome during pregnancy are usually mild and do not require treatment. However, if necessary, wrist splinting at night is the initial treatment that is recommended.

3-Leg cramps - Leg cramps 

• (involuntary spasms of the calf muscles) can affect between 30% to 50% of pregnant women and most commonly occur in the last three months of pregnancy.
• Leg cramps typically last only for a few seconds.

4-Round ligament

• Round ligament pain commonly occurs in the second trimester and manifests as a sudden, sharp pain in the groin area or lower abdomen, on one or both sides. Typically the pain only lasts for a few seconds.

• During pregnancy, the growing uterus can put stress on the round ligament of the uterus, causing it to stretch and leading to pain.

• Paracetamol (acetaminophen) is the recommended pain reliever for pregnant women with round ligament pain.

Fluid imbalance and kidney function

• Dehydration - Caused by expanded intravascular space and increased third spacing of fluids.

• Swelling/Edema - Swelling occurs when excess fluid accumulates in regions of the body, resulting in abnormal enlargement or "puffiness." This commonly occurs in the upper and lower extremities.
• Increased urinary frequency - Caused by increased intravascular volume, elevated GFR (glomerular filtration rate), and compression of the bladder by the expanding uterus.

Gastrointestinal (GI)

• burning pain(Heart Burn) in the chest, behind the breastbone that occurs when stomach acid travels up the esophagus and causes irritation.
• This sometimes happens in pregnancy due to the relaxation of the lower esophageal sphincter (LES), which normally keeps acidic stomach contents in the stomach.

• Constipation during pregnancy is thought to be due to decreased smooth muscle motility in the bowel caused by normal increases in progesterone constipation occurring in 11 - 38% of pregnant women.

• Treatment includes increased fiber and fluid intake, stool softeners, and laxatives.

• Hemorrhoids are common in pregnancy as a result of constipation and increased intra-abdominal pressure.

•  Hemorrhoids are enlarged veins near or inside the rectum, that can cause bleeding, pain, and itching.

• Treatment is symptomatic, including improving underlying constipation

• Symptoms may resolve spontaneously after pregnancy, although hemorrhoids may remain in the days after childbirth.

Skin and vasculature changes

• Diastasis recti - During pregnancy, the growth of the fetus exerts pressure on the abdominal muscles, rapid fetus growth in women with weak abdominal muscles, this pressure can cause the rectus abdominis muscle to separate along the linea alba, creating a split between the left and right sides of the rectus abdominis.

• Diastasis recti are common and occur more frequently as pregnancy progresses, up to and including labor.

• multiparity (twins, triplets, etc.), and diabetes have been identified as risk factors.

• Many cases of diastasis recti correct themselves after birth. In cases that persist, exercise may help, but sometimes surgery is needed to improve symptoms and prevent chronic problems

• Varicose veins -Dilation of veins in legs caused by relaxation of smooth muscle and increased intravascular pressure due to fluid volume increase.

• Treatment involves elevation of the legs and pressure stockings to relieve swelling along with warm sitz baths(a bath in which a person sits in water up to the hips. It is used to relieve discomfort and pain in the lower part of the body for example, due to hemorrhoids (piles), anal fissures, perianal fistulas, and rectal surgery) to decrease pain.

• Risk factors include obesity, lengthy standing or sitting, constrictive clothing, and constipation.

stretch marks 

• pregnancy-related stretch marks occur in 50% to 90% of women and are caused both by skin stretching and by the effects of hormonal changes on fibers in the skin.
• Stretch marks generally begin as red or purple stripes, fading to pale or flesh color after pregnancy that will generally be permanent.
• They appear most commonly on the abdomen, breasts, buttocks, thighs, and arms, and may cause itching and discomfort.
• Some treatments used to reduce scarring, such as topical tretinoin lasers, are sometimes used on stretch marks, but evidence of them is limited.
  
• Topical tretinoin has been shown to cause malformations in animals, without adequate human studies on safety in human pregnancies.

Generalized itching 

• It is a quite common complaint in pregnancy to have generalized itching which is not due to any systemic disease or any skin lesion.

• the itching is very frustrating and it may disturb sleep which leads to exhaustion and impaired quality of life. There is no clear satisfying treatment for this symptom. More research is needed to define possible, effective, and safe management.

summary

Common signs and symptoms of pregnancy include

• Tiredness.
• Morning sickness.
• Constipation.
• Back pain.
• Pelvic girdle pain.
• Braxton Hicks contractions. Occasional, irregular, and often painless contractions that occur several times per day.
• Peripheral edema swelling of the lower limbs.

• A common complaint in advancing pregnancy. Can be caused by inferior vena cava syndrome resulting from compression of the inferior vena cava and pelvic veins by the uterus leading to increased hydrostatic pressure in the lower extremities.

• Low blood pressure is often caused by compression of both the inferior vena cava and the abdominal aorta (aortocaval compression syndrome).

• Increased urinary frequency. A common complaint is caused by increased intravascular volume, elevated glomerular filtration rate, and compression of the bladder by the expanding uterus.

• Urinary tract infection

• Varicose veins. Common complaint caused by relaxation of the venous smooth muscle and increased intravascular pressure.

• Hemorrhoids (piles). Swollen veins at or inside the anal area. Caused by impaired venous return, straining associated with constipation, or increased intra-abdominal pressure in later pregnancy.

• Regurgitation, heartburn, and nausea.

• Stretch marks

• Breast tenderness is common during the first trimester, and is more common in women who are pregnant at a young age.

• Melasma, also known as the mask of pregnancy, is a discoloration, most often of the face. It usually begins to fade several months after giving birth.