SIGNS OF PREGNANCY 29T , 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 growths. 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 '