Palpation : Uterine height is palpated, the uterus feels soft and elastic, active fetal movements are felt.

Auscultation : Fetal Heart Sounds (F.H.S) it is the most conclusive clinical sign of pregnancy. It can be first heard between 20th and 24th week. The rate varies from 140 -160 per minute. Fetal movements are heard as dull thuds even when the movements are not forcible enough to be felt.

1.4.3 Changes in third Trimester

Symptoms : Amenorrhoea persists. Enlargement of the uterus is progressive. Lightening is felt at about 38 weeks. Frequency of micturition(urination) reappears. Fetal movements are more pronounced.

Signs : i) Cutaneous changes; Pigmentation and striae are more prominent. ii) Fundal height - The distance between the umbilicus and the ensiform cartilage is divided into three equal parts. The fundal height corresponds to the junction of the upper and middle third at 32 weeks, upto the level of

ensiform cartilage at 36th week and it comes down to 32 week level at 40th week because of engagement of the presenting part. To determine whether the height of the uterus corresponds to 32 weeks or 40