Goodell Sign

The Goodell sign is a clinical indication of early pregnancy. A positive Goodell sign is characterized by softening of the cervix, typically noticed in the first 4 to 8 weeks of pregnancy, While it can raise suspicion of pregnancy, it is not a definitive indication of pregnancy. 

The uterus is anatomically divided into 3 regions; the fundus (uppermost part), the body (main part), and the cervix (lower part). The cervical isthmus is a donut-shaped structure that connects the uterine cavity to the vagina and undergoes extensive changes during pregnancy, which are expressed with several signs and symptoms, including the Goodell sign; the Chadwick sign, characterized by bluish or purplish coloration of the cervix, vagina and labia; as well as light vaginal spotting. Other signs and symptoms of pregnancy include delayed menstruation, detection of human chorionic gonadotropin (hCG) in the blood or urine, and morning sickness.

The Goodell sign is caused by the hypertrophy (i.e., enlargement in size) of the existing vessels as well as the formation of new blood vessels in the cervix, which prepares the uterus for the implantation of a fertilized egg. Increased blood flow, specifically to the uterus, during early pregnancy, may give the vagina and cervix a bluish or purplish appearance, also known as the Chadwick sign. Edema due to increased blood circulation also plays a role in softening the cervix.

A pelvic examination allows for the identification of the Goodell sign. Following procedural consent, the examination begins with the individual urinating before, being positioned in the lithotomy position (i.e., where an individual’s legs are abducted at about 30 degrees, with the knees and hips bent at 90 degrees, while the calves are supported on padded leg stirrups). After the inspection of the external genitalia, healthcare professionals use a lubricated speculum to expand the vaginal wall and reveal the cervix. At this point, the blue coloration of the cervix associated with the Chadwick sign can be identified. Additionally, healthcare professionals typically use one hand to gently press the lower abdomen while two gloved fingers of the other hand palpate the vagina and cervix. During palpation, the consistency of the cervix can be examined and identified as soft or hard. The lower uterine segment (i.e., uterine isthmus), located above the cervix, can also become very soft in early pregnancy. Therefore, palpation of the uterine isthmus may be difficult during the bimanual examination, as its walls can become easily compressed (i.e., the Hegar sign).

The Goodell sign refers to a probable sign of pregnancy, characterized by softening of the cervix. A positive Goodell sign occurs due to increased blood flow noticed in the cervix during the first 4 to 8 weeks of pregnancy, which can also give the vaginal part of the cervix a bluish appearance (Chadwick sign). The Goodell sign, as well as other physical signs, can be identified during physical examination of the cervix, performed bimanually and with a speculum.