Signs of Pregnancy: Presumptive, Probable, Positive

3 different categories for the signs of pregnancy.

 PRESUMPTIVE
 PROBABLE
 POSITIVE

PRESUMPTIVE Signs of Pregnancy

Presumptive means speculation or unconfirmed.

These are signs of pregnancy the woman is experiencing that makes her suspicious she may be
pregnant. Therefore, these signs are based on her report of them…so they’re subjective. They are not
definite in that they indicate a baby is growing in the uterus because other conditions could cause these
presumptive signs (PMS is very similar to these signs). However, the woman could presume she may be
pregnant.
“Presume”
 Period absent (amenorrhea)
 Really tired (fatigue)
 Enlarged breast
 Sore breast
 Urination increased
 Movement of fetus in uterus…woman perceives fluttering sensation in her lower abdomen…this
is referred to as “quickening”
Quickening can occur at 16 weeks for 2nd time moms and around 20 weeks for 1st time moms
 Emesis and nausea

PROBABLE SIGNS OF PREGNANCY

Probable means likely to be the reason…probably…very likely.

These are pregnancy signs that the nurse or doctor can observe and document. However, these signs do
NOT mean 100% that a baby is growing in the uterus. It can be due to other causes.

“Probable”
 Positive pregnancy test
 Returning of the fetus (ex: bouncing back of the fetus) against the fingers when the uterus is
pushed during palpation. This is termed as “external ballottement”.
 Outline of fetus can be palpated
 Braxton Hicks Contractions: false labor contractions that are not regular and won’t result in
cervical dilation
 A softening of the cervix “Goodell’s Sign” ….happens around the 6-8th week of gestation
 Bluish color to the vulva, cervix, and vagina due to increased blood flow….happens around 4
weeks gestation “Chadwick’s Sign”
 Lower uterine segment (LUS) becomes soft “Hegar’s Sign”…happens around 6-12 week of
gestation
 Enlarged uterus
POSITIVE PREGNANCY TEST
Positive means conclusive, definite, or absolute.

Returning of the fetus (ex: bouncing back of the fetus) against the fingers when the uterus is pushed
during palpation. This is termed as “external ballottement”.
 Outline of fetus can be palpated
 Braxton Hicks Contractions: false labor contractions that are not regular and won’t result in
cervical dilation
 A softening of the cervix “Goodell’s Sign” ….happens around the 6-8th week of gestation
 Bluish color to the vulva, cervix, and vagina due to increased blood flow….happens around 4
weeks gestation “Chadwick’s Sign”
 Lower uterine segment (LUS) becomes soft “Hegar’s Sign”…happens around 6-12 week of
gestation
 Enlarged uterus

POSITIVE SIGNS OF PREGNANCY

These signs are present because they can only be attributed to a FETUS. There is no other cause. The
woman is definitely pregnant. The signs will deal with the baby being the evidence itself.
 “FETUS”
 Fetal movements felt by doctor or nurse
 Electronic device detects fetal heart sounds (Doppler)
 The delivery of the baby
 Ultrasound detects the fetus
 See visible movement of the baby by the doctor or nurse

GRAVIDITY AND PARITY MATERNITY

Gravidity and parity are terms you must be familiar with when taking
maternity nursing. These terms are helpful in communicating a
patient’s health history regarding pregnancies and births.

Gravidity and Parity Maternity Nursing

Gravidity and parity are terms used in maternity nursing to help us

communicate a patient’s pregnancy and birth history. There are
actually two systems that are used in maternity to help with this type of
communication.
One system is the five-digit system called the GTPAL.

GTPAL stands for

Gravidity: number of times the woman has been pregnant (This Includes Current Pregnancy,
Miscarriages, Abortions And  *Twins/Triplets Count As One).
Term Births: number born (alive or stillborn) at 37 weeks gestation onward (*twins/triplets count as
one)
Preterm births: number born 20-37 weeks (alive or stillborn) (*twins/triplets counts as one)
Abortion: pregnancy losses before 20 weeks  (counts as a pregnancy…so would put in gravidity as
well)** if baby died after 20 weeks it is added under preterm or term not abortion.
Living children: number of children living (NOTE: twin/triplets counts individually)
GTPAL Practice Questions
Question 1: A 26 year old female is currently 26 weeks pregnant. She had a miscarriage at 10 weeks
gestation five years ago. She has a three year old who was born at 39 weeks. What is her GTPAL?
Answer: G=3, T=1, P=0, A=1, L=1

Question 2: A 35 year old female is currently pregnant with twins. She has 10 year old triplets who were
born at 32 weeks gestation, and 16 years old who was born at 41 week gestation. Twelve years ago she
had a miscarriage at 8 weeks gestation. What is her GTPAL?
Answer: G=4, T=1, P=1, A=1, L=4

Gravidity and parity is a two-digit system and this is what we will concentrate on in this review.
Gravidity is the number of times a woman has been pregnant. Another term used to describe gravidity
is gravida. When you are trying to determine the gravidity, keep the following in mind:
 The outcome of each pregnancy (meaning…did the baby live or did the mom lose the baby?)
is not  relevant. So in other words, if the baby lived or did NOT we still count this as a pregnancy.
 The current pregnancy is included in the count. Don’t let this confuse you when you are
answering test questions…always make sure you count the current pregnancy (if she is
pregnant) with the other past pregnancies.
 Multiple babies? We’re not counting the number of babies BUT just the pregnancy itself.
Therefore, if the woman is pregnant with twins, triplets, quadruplets etc., the gravida is just
ONE.
Parity is the number of times a woman has birthed or completed a pregnancy (meaning the baby is no
longer inside mom’s body) at 20 weeks gestation or greater. When you are trying to determine the
parity, keep the following in mind:
 The count includes babies born alive or stillborn at 20 weeks gestation or greater.
 Multiple babies? Just like with gravidity, we’re not counting the number of babies born/birthed.
Therefore, if a mom completes a pregnancy at 20 weeks gestation or greater with twins, triplets,
quadruplets etc., the parity is just ONE.
Now, for each term you need to be very familiar with their individual terms. If you look at them below
you can tell that their prefixes (nulligravida vs nullipara) are the same BUT their suffixes are different.
Therefore, if you know the meaning of each prefix and the correct definition of the suffix, determining
the meaning of each word is easy.
Prefix meanings:
 Nulli: never or none
 Primi: first
 Multi: many
Terms to Know:
 Nullipara: a woman has never completed a pregnancy at 20 weeks gestation or greater.
 Nulligravida: a woman has never been pregnant.
 Primipara: a woman has only once completed a pregnancy at 20 weeks or greater.
 Primigravida: a woman has been pregnant once or is currently pregnant for the first time.
 Multipara: a woman has completed two or more pregnancies at 20 weeks gestation or greater.
 Multigravida: a woman has been pregnant two or more times.
Gravida and Parity Examples (Scenarios)
Example 1: During the health history collection on a female patient at a women’s health clinic visit, the
patient tells you she is not currently pregnant but has been pregnant three times before. She states that
at 39 weeks gestation she gave birth to a boy. However, the other two pregnancies ended at 7 and 10
weeks gestation. How would you calculate the patient’s gravidity and parity?
Answer: Gravida 3, Para 1
Rationale: The patient is NOT currently pregnant so we won’t count this in the gravida. However, she
has been pregnant three times before. So, her gravida is THREE. The patient further explains that she
has only completed ONE pregnancy at 39 weeks and the other two were completed at 7 and 10 weeks
gestation. Remember parity is the number of pregnancies completed at 20 weeks gestation or more.
Therefore, the patient’s parity is 1.

Example 2: A patient is pregnant with twins at 30 weeks gestation. This is her first pregnancy. How
would you calculate the patient’s gravidity and parity?
Answer: Gravida 1, Para 0
Rationale: This is the patient’s FIRST pregnancy. Therefore, gravida is ONE (remember that the number
of babies is NOT added to the gravidity). She is still pregnant and has not completed the pregnancy yet.
Therefore, the parity is ZERO.
*However, let’s say she gives birth at 38 weeks gestation to twins. What would the gravidity and parity
be now? Gravida 1, Para 1 (the parity changes since she has now completed the pregnancy…again the
para ISN’T two because we don’t calculate the number of babies).