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Chadwick Sign

What Is It, Causes, and More

Author:Ali Syed, PharmD

Editors:Alyssa Haag,Emily Miao, PharmD,Kelsey LaFayette, DNP, RN

Illustrator:Jessica Reynolds, MS

Copyeditor:Sadia Zaman, MBBS, BSc


What is the Chadwick sign?

The Chadwick sign is a non-specific, early sign of pregnancy that is typically characterized by a bluish discoloration of the cervix, vagina, and vulva. The Chadwick sign can typically be observed as early as six to eight weeks after conception, and commonly disappears shortly after birth. It does not commonly present with any other specific signs and symptoms such as pain, but may coexist with signs and symptoms of the underlying condition. While the Chadwick sign is commonly associated with pregnancy, some conditions that may mimic signs of pregnancy and have a positive Chadwick sign, include cervical endometriosis, a condition characterized by endometrial lesions outside the uterine cavity; the presence of endometrial tissue in the uterine muscle (i.e., adenomyosis); and false pregnancy (i.e., pseudocyesis). 

The Chadwick sign is not a definitive indication of pregnancy, and the absence of it on physical exam does not exclude a potential pregnancy. Other non-specific early signs of pregnancy include the Goodell and Hegar signs. The Goodell sign is characterized by the softening of the cervical area, whereas the Hegar sign is characterized by the compressibility and softening of the cervical isthmus (i.e., the portion of the cervix between the uterus and the vaginal portion of the cervix). 

Enlarged illustration of a cervix during pregnancy with a bluish tint.

What causes the Chadwick sign?

The Chadwick sign is typically caused by various physiological changes that occur during the early stages of pregnancy. Early in pregnancy, increased venous blood flow to the cervix, vagina, and vulva, triggered by an increase in various hormones (i.e., estrogen, progesterone) and prostaglandin synthesis, may alter cervical tissue composition and lead to a bluish discoloration in the area.   

Individuals may seek medical advice to have the Chadwick sign assessed. A thorough medical history, physical examination, laboratory tests and ultrasound imaging may be completed by a medical professional. If pregnancy is not the underlying cause, other conditions that can mimic pregnancy and cause a positive Chadwick sign may be investigated and treated accordingly. For example, cervical endometriosis may be characterized by red, black and/or blue cervical lesions; adenomyosis may affect the cervix resulting in discoloration; and pseudocyesis may trigger a release of pregnancy hormones which can result in the Chadwick sign.

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What are the most important facts to know about the Chadwick sign?

The Chadwick sign is a non-specific, early sign of pregnancy that is typically characterized by a bluish discoloration of the cervix, vagina, and vulva. The Chadwick sign usually presents six to eight weeks after conception, and commonly disappears shortly after birth. It is typically a result of the various biochemical and blood flow changes in early pregnancy that impact the cervix. While the Chadwick sign is commonly associated with pregnancy, some conditions may mimic signs of pregnancy and have a positive Chadwick sign like endometriosis, adenomyosis, or pseudocyesis. It can be assessed by a medical professional through visual examination of the cervix, vagina, and vulva.

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Related links

Pregnancy
Estrogen and progesterone

Resources for research and reference

Christiansen, S. (2021). What is Chadwick’s Sign? In Verywell Health. Retrieved May 24th 2022 from: https://www.verywellhealth.com/chadwick-sign-diagnosis-indications-other-causes-5191239

Health Jade Team. Chadwick sign. In Health Jade. Retrieved May 24th, 2022, from: https://healthjade.net/chadwick-sign/#google_vignette

Ingber, A. (2009). Physiologic vascular changes during pregnancy. Obstetric Dermatology: A Practical Guide (pp. 33-44). Jerusalem: Springer.

Muallem, M. M., & Rubeiz, N. G. (2006). Physiological and biological skin changes in pregnancy. Clinics in Dermatology, 24(2): 80-83. DOI: 10.1016/j.clindermatol.2005.10.002

Sel, G. (2020). Physiological changes during pregnancy. Practical guide to oral exams in obstetrics and gynecology (pp. 29-37). Zonguldak: Turkey.