= Solution
\b[Separate evidence produced by the mother from evidence identifying the <fetus>.] The classical presumptive, probable and positive grouping expresses increasing diagnostic confidence; it is not a numerical probability scale.
\b[Presumptive signs] include missed <menstruation>, nausea or <pregnancy-associated vomiting>, <breast> enlargement and tenderness, changes in the <areola>, urinary frequency and the mother's sensation of <fetal movement>, traditionally called <quickening>. Each can have another explanation. <Amenorrhoea> may result from illness or endocrine disturbance; abdominal enlargement can arise from a pelvic mass, <ascites> or other causes. A report of movement is not equivalent to movement detected independently by the examiner.
\b[Probable physical signs] include a progressively enlarged <uterus> with the appropriate change in contour, softening of the <cervix> and uterine tissues, increased vascularity and colour change of the genital mucosa, and intermittent <uterine contractions>. <Ballottement> is the rebound of a movable object within fluid when it is displaced: in the right clinical setting it supports a gravid <uterus>, but the physical phenomenon alone does not identify a living <fetus>. A vascular sound heard over the <uterus> follows the maternal circulation and is not the fetal heartbeat.
\b[Positive evidence available to the 1865 examiner] was a fetal heartbeat heard with a <stethoscope>, unmistakable fetal movements appreciated during examination, and identification of fetal parts. Repeated examination as <pregnancy> advances strengthens their interpretation. The examiner should compare the perceived heartbeat with the maternal pulse rather than accept any abdominal sound as fetal. These findings generally become useful later than the earliest symptoms, so their absence early on does not exclude <pregnancy>. The mother’s <quickening> remains a symptom; independently established <fetal movement> is a different kind of evidence.
\b[Modern additions.] <Human chorionic gonadotropin> testing can detect <pregnancy>-related tissue before the classical physical signs become conclusive. A positive test does not establish location or continuing viability: it can occur in <ectopic pregnancy> and must be interpreted in context. <Ultrasound> can establish location and show an embryo or <fetus> with cardiac activity. Very early uncertain findings may require repeat assessment rather than a premature conclusion. These technologies are later developments, not signs that an 1865 candidate could have obtained. <Evaluation of the Obstetric Patient by Merck Manual>[Diagnosis and confirmation of pregnancy: hormonal testing, ultrasound, fetal heart activity and examiner-detected movement]{ref} <Ectopic pregnancy and miscarriage by NICE>[NG126 §§1.5–1.8: pregnancy location, repeat scans and the limits of serum hCG]{ref}
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