Goodell Sign · What Is It, Causes, Findings, and More

The Goodell sign refers to 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 for pregnancy, it’s not a definitive indication of pregnancy.  

The uterus is anatomically divided into three regions: the fundus (uppermost part), the body, 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; as well as the Chadwick sign, characterized by bluish or purplish coloration of the cervix, vagina, and labia. Other signs and symptoms of pregnancy include delayed menstruation, detection of human chorionic gonadotropin (hCG) in the blood or urine, and morning sickness. 

A pelvic examination is an essential step for the identification of early signs of pregnancy, like the Goodell sign. The individual is asked to urinate before the examination begins to minimize discomfort during the physical exam. Following procedural consent, the individual is positioned in the lithotomy position (i.e., 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 firm. The cervix usually feels firm, similar to the tip of the nose, whereas a softened cervix (i.e., Goodell sign) feels more like the texture of lips. The lower uterine segment (i.e., uterine isthmus), located above the cervix, can also become very soft in early pregnancy (i.e., the Hegar sign). Therefore, palpation of the uterine isthmus may be difficult during the bimanual examination, as its walls can become easily compressed.