Obstetrics — Common Presentations
Normal Pregnancy
Overview and approach
Normal pregnancy is managed with regular antenatal visits, screening, education and planning for labour. Offer early first visit (ideally before 10 weeks) (1). See also Routine Antenatal Care and Pre-conception counselling.
Assessment and clinical features
First-trimester symptoms, physiological changes (2nd/3rd trimester), first-visit checklist, antenatal education and stages of labour are in the notes below.
Differentials and investigations
- Prenatal screening for fetal chromosome conditions is available from 10 weeks (non-invasive prenatal screening using cell-free DNA) alongside combined first-trimester and second-trimester screening and reproductive carrier screening (2).
- GBS: the QCG recommends a risk-based approach to intrapartum antibiotic prophylaxis; routine universal screening is not recommended in Queensland, though swabs at 35 to 37 weeks may be appropriate for individual women (3).
Signs and Symptoms of Pregnancy (1st Trimester)
- Amenorrhoea
- Nausea/ Vomiting
- Breast changes (subtle – tender)
- Fatigue
- Urinary Frequency
- Jacquemier’s sign (blue or purplish colour of the vaginal mucosa)
- Uterine enlargement
- Positive urine test (human gonadotrophic hormone).
- After 12-weeks gestation the fundus can be felt just above the symphysis pubis
Notes
First Visit
- To confirm pregnancy
- To establish a baseline
- History- family, medical (mental conditions, illnesses), surgical (cervical, uterus, pelvic, bladder, bowel, spinal, breast implants/reduction), gynaecological (contraception, missed a pill, pap smear, abnormal result, STI, check-ups, PCOS, ovarian pathology), obstetric (first pregnancy, children) and psychological
- Examination- posture, stance, height, weight, urinalysis
- Bloods- group, Rhys factor, haemoglobin, screening for syphilis (R.P.R), rubella, HIV, Hep B, Hep C.
Physiological changes (2nd Trimester)
- Amenorrhoea
- Probable cessation of vomiting
- Quickening –foetal movement, felt 16-20 weeks in a multi, later in a primagravida
- Secondary areola (darkened area around breast tissue)
- Skin changes (stretch marks (permanent), linea nigra (deposit of melanin in fascia), chloasma (mask of pregnancy, melanin deposits on face))
- Foetal parts are felt
- Foetal heart heard
- At 18 weeks fundus felt 1⁄2 way between umbilicus and symphysis pubis
- At 24 weeks fundus felt above the umbilicus
Physiological changes (3rd Trimester)
- Amenorrhea continues
- Pressure symptoms: breathlessness, increased micturition
- Blood Glucose, Antibody screen FBC at 26-28 weeks
- Braxton Hicks contractions (painless tightening, irregular, from sex/physical activity/nothing/UTI, regular —> pre-term labour)
- At 30 weeks fundus is felt halfway between umbilicus and xiphisternum, then at 36 weeks, at the xiphisternum
- Group B Strep swab can be done from 37 weeks on – for natural birth
- Offer anti D to Rhesus negative women (625iu) at 28 and 34 weeks.
Notes
Antenatal Education
- Information for pregnant mothers
- Smoking and alcohol
- Exercise and Rest
- Dental Care and Hygiene
- Travel
- Dietary guidelines
- Dietary requirements
Stages of labour
First Stage
Latent (1-4cm)
- oxytocin > adrenaline
- 30 seconds, 10mins aparts
- can be on for 24 hours
- blur of contractions
Active (4-8cm)
- Regular painful contractions
- 45-60seconds, 2-3mins apart
- How many in 10minutes
- 3-4 in 10 minutes = good
- more than 5 in 10 minutes = bad
- regular and easy to palpate
- Triangular fontanelle between cervix palpated
Mechanisms of normal
Management and follow-up
- Ongoing antenatal visits, BP, fundal height, fetal movements and growth review per local schedule; routine anti-D prophylaxis for RhD-negative women (625 IU at 28 and 34 weeks).
- Offer folate, iodine and vaccination advice (influenza, pertussis, COVID-19 per Immunisation Handbook).
- Labour: see Normal labour page (3 stages; modified active third stage) (4).
Red flags and clinical pearls
- Reduced fetal movements, antepartum bleeding, severe headache with hypertension, abdominal pain, fluid leakage: same-day assessment. See linked pages (Antepartum bleeding, Hypertension in pregnancy).
- Stillbirth and preterm birth risk factors include smoking, age extremes, hypertension, diabetes.
References
Last updated from Sen’s notes on 9 October 2026.