ANTEPARTUM | SIGNS AND SYMPTOMS | Maternity

Signs of Pregnancy at a Glance

Signs of pregnancy are grouped by who detects them and how certain they are. NCLEX asks you to classify a finding and to choose the sign that confirms pregnancy.

Category	Who Detects It	Confirms Pregnancy?	Memory Tool
Presumptive	The client (subjective)	No	“Mom feels it”
Probable	The examiner (objective)	No — strong indicator	“The examiner finds it”
Positive	The examiner, with direct fetal evidence	Yes	“FETUS”

NCLEX TRAP: When a question asks which sign confirms pregnancy, only a positive sign is correct. A positive pregnancy test is probable, not positive.

Presumptive Signs — Subjective

Reported by the client; not diagnostic because other conditions can cause them.

Sign	Notes
Amenorrhea	Missed period; also caused by stress, illness, weight loss, or menopause
Nausea and vomiting	Usually 4–12 weeks; can occur at any time of day
Breast changes	Tenderness, enlargement, darker areola
Fatigue	Related to rising progesterone
Urinary frequency	Uterus presses on the bladder (first and third trimesters)
Quickening	First fetal movement felt by the client, 16–20 weeks; can be confused with gas or peristalsis
Skin changes	Chloasma (melasma), linea nigra, striae gravidarum

THINK SIMPLE

If the client reports it and no examiner confirms it, it is presumptive. Quickening is presumptive because the mother can mistake gas for movement.

Probable Signs — Objective

Observed, felt, or measured by the examiner; strong indicators but not conclusive.

Sign	Description	Usual Timing
Goodell’s sign	Softening of the cervix	About 6–8 weeks
Hegar’s sign	Softening of the lower uterine segment (isthmus)	About 6–8 weeks
Chadwick’s sign	Bluish-purple color of the cervix, vagina, and vulva	About 6–8 weeks
Positive pregnancy test (hCG)	Detects the hormone hCG in blood or urine; can be falsely positive with molar pregnancy, some tumors, or medications	Within days of implantation
Abdominal and uterine enlargement	Growing uterus	After 12 weeks, palpable abdominally
Braxton Hicks contractions	Irregular, painless, no cervical change	Often noticed in the second half of pregnancy
Ballottement	Fetus rebounds when the cervix is tapped	About 16–20 weeks
Palpation of fetal outline	Examiner feels the fetal shape	Second half of pregnancy

MEMORY TOOL — ABC ORDER, BOTTOM TO TOP

Chadwick = Color (bluish). Goodell = Good and soft cervix. Hegar = Higher up — the lower uterine segment.

THINK SIMPLE

The examiner can see, feel, or measure these — but they do not directly show the fetus. That is why a positive hCG test is still only probable.

Positive Signs — Definitive

Direct evidence of the fetus — seen, heard, or felt by the examiner.

Sign	Usual Timing
Fetal heart tones by Doppler	About 10–12 weeks (fetoscope: about 18–20 weeks)
Ultrasound visualization of the gestational sac, embryo, or cardiac activity	Gestational sac at about 5 weeks; cardiac activity at about 6 weeks (transvaginal)
Fetal movement felt or seen by the examiner	After about 20 weeks

MNEMONIC — FETUS

Fetal movement felt by the examiner · Electronic device (Doppler) detects fetal heart tones · The birth of the fetus · Ultrasound shows the fetus · Seen fetal movement by the examiner

Uterine Anatomy Review

Anterior view of the female reproductive organs labeling the uterus, cervix, vagina, fallopian tubes, fimbriae, and ovaries — Female reproductive organs: uterus, cervix, vagina, fallopian tubes, fimbriae, and ovaries.

The lower uterine segment (isthmus) is the narrow area between the body of the uterus and the cervix. Knowing these landmarks helps you tell apart Goodell’s sign (cervix), Hegar’s sign (lower uterine segment), and Chadwick’s sign (cervix, vagina, and vulva).

Additional Uterine Signs (Beyond NCLEX)

These eponyms appear in some textbooks. They are all probable signs found by the examiner, but NCLEX focuses mainly on Goodell’s, Hegar’s, and Chadwick’s signs, ballottement, and Braxton Hicks contractions.

Sign	Description	Usual Timing
Palmer’s sign	Regular, rhythmic uterine contractions felt during bimanual examination	4–8 weeks
Von Braun-Fernwald’s sign	Irregular softening and enlargement of the fundus at the implantation site	5–8 weeks
Piskacek’s sign	Asymmetric uterine enlargement; one side firmer than the other	6–8 weeks
Ladin’s sign	Softening at the midline of the anterior uterine isthmus	About 6 weeks
McDonald’s sign	Increased flexibility; the uterus flexes easily on the cervix	6–8 weeks
Osiander’s sign	Increased pulsation of the uterine arteries felt in the lateral fornices	About 8 weeks

SAFETY NOTE: Light spotting can occur at implantation, but any vaginal bleeding during pregnancy must be reported and evaluated to rule out miscarriage, ectopic pregnancy, or other complications.

NCLEX Self-Check — Signs of Pregnancy

Select the best answer for each question. Press Submit Answer to view your result and the rationale for every option.

Question 1 of 10

How NCLEX Tests Signs of Pregnancy

NCLEX asks you to classify findings, choose the sign that confirms pregnancy, match the uterine signs to their descriptions, and recognize findings, such as bleeding, that need follow-up.

Clinical Judgment	Application
Recognize Cues	Identify who reports or detects each finding.
Analyze Cues	Classify findings as presumptive, probable, or positive.
Prioritize Hypotheses	Identify findings that need urgent evaluation, such as bleeding or pain.
Generate Solutions	Plan confirmation with ultrasound or Doppler.
Take Action	Teach the client and report concerning findings.
Evaluate Outcomes	Confirm pregnancy and establish accurate dating.

NCLEX KEY POINT

Client feels it → presumptive. Examiner finds it → probable. Examiner sees, hears, or feels the fetus → positive. A positive hCG test is probable.