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, but it may be found in soft uterine myomata. C. J. Gauss T
published in 1920 a modification of Hegar's sign. The cervix presents in the
first and second months of pregnancy an abnormal motility. It may easily
be pushed to either side without entailing a corresponding movement of the
uterus. This phenomenon is comparatively rare outside of pregnancy.

6.    Enlargement   of   the   Abdomen.—The   abdomen   begins   to   enlarge
gradually after the third month.    Upto the first three months the gravid
uterus remains in the cavity of the pelvis, and about the fourth month rises
just above the symphysis pubis and comes into contact with the abdominal
wall.   At the end of the fifth month it is midway between the symphysis
and the umbilicus   (naval).   At the end of the sixth month it reaches the
level of the umbilicus, and at the end of the seventh month it is midway
between the umbilicus and the ensiform cartilage.    At the end of the eighth
month and in the early part of the ninth month it reaches the ensiform
cartilage or epigastrium.    During the last two months the uterus on account
of its weight does not rise higher, but sinks deeper into the pelvis and tends
to fall forward.

The enlargement of the abdomen may occur in ascites, ovarian cysts,
ovarian and uterine tumours, and phantom tumours.

7.    Intermittent   Uterine    Contractions.—Throughout    pregnancy,    the
uterus is subject to alternate contractions and relaxations, but before the
third month it is difficult to observe them except by a very careful bimanual
examination.    After  the  fourth  month   the  uterus   can  be   easily felt   as
alternately contracting and relaxing by palpating the abdomen.   The period
of contraction and relaxation is variable, each contraction lasting from one
to five minutes,  and each relaxation from five to twenty minutes.   This
phenomenon   is  known  as   Braxfon  Hick's   sign,   and  is   considered  as  a
valuable proof of pregnancy.   It is present even when the foetus is dead or
degenerated.   It   may   sometimes  be   present   in   cystic   distension  of  the
uterus,  in large soft uterine myomata  or in large intra-uterine  polypoid

8.    Foetal Movements.—Foetal movements are felt and seen through the
abdomen after the sixth month.   They may be felt on bimanual examination
through the vagina at the commencement of the third or fourth month, and
may be heard on auscultating the abdomen about the middle of the fourth
month.   The foetal parts may also be palpated through the abdominal wall.
This is a certain sign of pregnancy.

9.    Uterine Souffle.—The uterine souffle is described as a soft, blowing
murmur, synchronous with the mother's pulse, and heard towards the end
of the fourth month  on  either  side  of the uterus  just  above Poupart's
ligament.    In some cases it may be heard as early as the ninth or tenth
week.   This sign is not infallible, because it may be heard in uterine or
ovarian tumours.

10.    Fcetal Heart Sounds.—The sounds  of the  foetal heart  constitute
by far the most important sign of pregnancy.   They are usually heard for
the first time in the course of the fifth month, generallv from the eighteenth
to the twentieth week, and are compared to the muffled ticks of a watch
under a pillow.   They vary in rate from one hundred and twenty to one
hundred and sixty per minute, and are not synchronous with the mothers
pulse.   They are not heard when ihe foetus  is  dead,  when there i
excessive quantity of liquor amnii or when the abdominal wall is very <f

11.    BaUottement—This is the name given to the sensation ol        ^*«^
moving the foetus about in the. liquor amnii.   It can be felt i

7.   Zentralblatt fwr Gi/nakologie, Leipzig,  April 3,  1926,  p. 875; -
June 5, 1926, p. 1,810. t   '