1.1 Diagnosing pregnancy

1.1.1 Signs and symptoms of pregnancy

– The first sign of pregnancy is amenorrhea1 combined with a progressive increase in the size of the uterus starting 7 to 8 weeks after the last menstrual period.
– During the first trimester, breast changes (increased size, tenderness, vascularisation and swollen areolas), urinary frequency and transitory nausea/vomiting are common.
– In the second trimester the mother begins to feel foetal movement and, in some cases, uterine contractions. Foetal heart tone can be heard.
Signs and symptoms of pregnancy by gestational age are presented in the Table 1.1.

Table 1.1 - Signs and symptoms of pregnancy by gestational age

1.1.2 History and clinical examination

See Section 1.2.

1.1.3 Other investigations

Pregnancy test

While a pregnancy test is not routinely necessary, it is indicated for suspected ectopic pregnancy or early diagnosis of a pregnancy to be terminated.


Ultrasound is not routinely necessary.

Ref Notes
1 For amenorrhoea (absence of menstrual periods) without other signs of pregnancy, rule out other causes: physiological (breastfeeding), drug-related (e.g. contraceptives up to 3 months after stopping, antipsychotics and corticosteroids), endocrine (e.g. thyroid disorder), psychological, nutritional, etc.