PRENATAL ASSESSMENT

VERIFYING PREGNANCY
PRESUMPTIVE SIGNS
 Amenorrhea
 Nausea, vomiting, morning sickness, fatigue
 Frequency of micturition
 Breast tenderness, fullness, pigmentation
 Quickening ( 5 months )
 Chadwick’s sign
 Pigmentation of skin and abdominal striae

PROBABLE SIGNS
 Enlargement of abdomen
 fetal outline distinguished by abdominal palpation
 Hegar’s & Goodell’s sign
 Braxton hicks contractions
 Positive pregnancy test*

POSITIVE SIGNS
 Fetal heart sounds
 Fetal movements felt by examiner
 Ultrasound

*Pregnancy test – HCG in urine 2 wks after missed period

 PRENATAL ASSESSMENT
HISTORY TAKING
•PERSONAL DATA & HEALTH FACTORS
•OBSTETRICAL DATA
 Gravida – number of pregnancies a woman has had
Primigravida . Multigravida
 Para – number of viable pregnancies
Nullipara . Primipara . Multipara
 FPAL score = Full term, Premature deliveries,
Abortions, Living children
 GTPAL = Gravida, Term, Preterm, Abortions, Living
 Past pregnancies – method of delivery, where, risks
 History of sexually transmitted diseases
 PRENATAL ASSESSMENT
HISTORY TAKING
 Present pregnancy : discomforts & management,
danger signals, emotional status
 Danger signs: vaginal spotting, swelling of face or
fingers, severe continuous headache, blurring of
vision, light or dots before eyes, pain, persistent
vomiting, sudden escape of fluid from vagina, chills
and fever, absence of fetal heart sounds
•NUTRITIONAL STATUS
 24 Hour diet recall
 there should be no attempt for weight reduction
 Check iron & calcium supplement, decrease sodium
 PRENATAL ASSESSMENT
HISTORY TAKING
•PARAMETERS FOR ASSESSMENT OF DATE OF DELIVERY
 Näegele’s rule –
- Determine EDC ( expected date of
confinement ) by taking the LMP ( last menstrual
period ) subtract 3 months, add 7 days, and add 1
year except if LMP is in the 1st 3 months of the year
 Mc Donald’s Method
- Determines AOG by measuring
the fundus to the symphysis pubis ( in cm ) then
dividing it by 4 to get AOG in months
ht (cm) x 2 / 7 = gestation in lunar months
Ht (cm) x 8 / 7 = gestation of pregnancy in weeks

 PRENATAL ASSESSMENT
HISTORY TAKING
•PARAMETERS FOR ASSESSMENT OF DATE OF DELIVERY
 Bartholomew’s rule
– use estimates by relative positions of the
uterus in the abdominal cavity using
landmarks: 3 L months – palpable slightly at
symphysis pubis, 5 L months – fundus is at
level of umbilicus, 9th L month – fundus
is below xyphoid
 Haase’s Rule – determines length of fetus in cm.
1st half: square the number of the month
2nd half: multiply the month by 5
 Johnson’s rule – estimates weight of the fetus
formula: fundic height (cm) – n x k ( k= 155 )
n = 12 ( if fetus is engaged ), 11 ( if not engaged )
 Sonography
 PRENATAL ASSESSMENT
PHYSICAL ASSESSMENT
•INITIAL VISIT – Complete physical assessment
 Pelvic exam = I.E. ( internal exam )
cardinal rule – empty the bladder first
determine Chadwick’s, Goodell’s, Hegar’s signs
Ballottment (palpate baby causing to move–bounce)
Pap smear, culture, bimanual exam (palpation)
Leopold’s maneuver (4 maneuvers)
Pelvic measurement – after 6th month detect CPD
 Vital signs - baseline
 Review of systems including teeth
•ROUTINE VISITS
 Every 4 weeks until 32 weeks
 Every 2 weeks until 36 weeks
 Every week until delivery
 PRENATAL ASSESSMENT
PHYSICAL ASSESSMENT
•LABORATORY SCREENING
 Pregnancy test = HCG
 Heat & acetic acid test = albuminuria
 Maternal serum alpha-fetoprotein (AFP) 16-18 wks
to detect neural tube defects
 Glucose screening 24-28 weeks ( OGTT, OGCT )
 Rh antibody titers (Rh+) at 24,28,32,36 and 40 wks
 CBC, blood typing
 PRENATAL ASSESSMENT
DISCOMFORTS OF PREGNANCY
•FIRST TRIMESTER
 Nausea & vomiting – dry crackers before arising,
small feedings of bland food, milk
 Urinary frequency & urgency – do not restrict H2O
 vaginal discharge – good hygiene (no douching),
wear loose-fitting cotton underwear, report signs &
symptoms of vaginitis
 Breast soreness – well fitting, supportive brassiere
 Headache – due to tension. Relaxation techniques.
Report persistent or severe episodes
 PRENATAL ASSESSMENT
DISCOMFORTS OF PREGNANCY
SECOND & THIRD TRIMESTER
 Heartburn – small frequent meals, discourage
overeating, fatty foods, lying down after eating &
usage of NaHCO3. Increase fluid intake
 Constipation – fluid, fiber, exercise
 Hemorrhoids – bowel habit regulation, ice packs,
ointments, sitz bath, lying down with legs elevated
 Braxton Hick’s – rest, change position or activity
 Backache – good posture
 Faintness – gradual movement, no prolonged
standing & warm environment, elastic hose
 Leg cramp–calcium supplement, dorsiflexion of feet
 Ankle edema – no constrictive clothing, elevate
legs, dorsiflex, BP assessment, limit sodium intake
 Varicosities – elevate legs, no cross leg, use stockings