Pregnancy may be suspected in any sexually active woman, of childbearing age, whose menstrual period is delayed, particularly if combined with symptoms of early pregnancy, eg:

• Nausea (1st trimester)
• Breast and nipple tenderness (1st trimester)
• Marked fatigue (1st and 3rd trimesters)
• Urinary frequency (1st and 3rd trimesters)
• The patient thinks she's pregnant

Early signs of pregnancy may include:

• Blue discoloration of the cervix and vagina (Chadwick's sign)
• Softening of the cervix (Goodell's sign)
• Softening of the uterus (Ladin's sign and Hegar's sign)
• Darkening of the nipples
• Unexplained pelvic or abdominal mass

Pregnancy should be confirmed with a reliable pregnancy test. Urine or serum pregnancy tests can be used. Both are reliable and detect human chorionic gonadotropin (HCG). Pregnancy is considered present if 30-35 mIU of HCG are present in the urine or serum.
Ultrasound may be used to confirm a pregnancy, if the gestational age is old enough for visualization of a recognizable fetus and fetal heartbeat (usually 6 weeks or greater).

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