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ASSESSMENT

IN
PRE-NATAL VISIT

MELBA GRACE T. DONIO, RN

Prenatal Care Visitis a type of


preventive healthcare with the
goal of providing regular checkups that allow medical
professionals to treat and
prevent potential health
problems throughout the course
of the pregnancy while
promoting healthy lifestyles that
benefit both mother and child.

Maternal Health Program of


the DOH
is tasked to reduced the maternal
mortality ratio by three-quarters by
2015:
MMR of 112/100,000 live births in
2010
MMR of 80/100,000 live births in
2015

Strategic Thrusts for 20052010


Launch and implement the Basic Emergency Obstetric
Care or BEMOC. The BEMOC strategy entails the
establishment of facilities that provide emergency care for
every 125,000 population.
Improve the quality of prenatal and postnatal care
Reduce womens exposure to health risks through the
institutionalization of responsible parenthood and
provision of appropriate health care package to all women
of reproductive ages.
LGUs, NGOs and other stakeholders must advocate for
health through resource generation and allocation of
health services for the mother and the unborn.

PRENATAL VISIT SCHEDULE


Schedule of first visit is as soon as the woman missed her
menstrual period and pregnancy is suspected

1st trimester (1st 32 weeks): once a


month
2nd (32-36 weeks): twice a month
3rd (36-40 weeks): every

week

Assessment
I. Obtain Biographical Data
a.MARITAL STATUS
b.OCCUPATION
c.RELIGION
d.CULTURAL BACGROUND
II. Health history

Menstrual history: menarche, regularity, frequency and


duration of flow and last period.
Obstetrical history; all pregnancy, outcome, complication,
contraceptives use, sexual history, type of birth
History of past illnesses
History of family illness
III. Current Health Problems

FORMULA USED TO
ESTIMATE PREGNANCY
Determining the Last Menstual Period (LMP)
First day of last menstruation
Determining the Expected date of delivery
(EDC)
A. Naegeles Rule
For LMP between April to December:
- 3 (months) +7 (days) +1 (Year)
For LMP betwen January to March:
+ 9 (months) +7 (days)

Determining the Age of Gestation (AOG)


Number of days since LMP to the present day divided by 7
B. Mc Donalds Rule
Formula: AOG (months)= Fundic height (in cm) 4
***For 20 weeks AOG and above:

FUNDIC HEIGHT (CM) = AOG (WEEKS)

**For below 20 weeks AOG:


= FH (CM) x 8 / 7
= AOG in weeks
C. Bartholomews Rule estimates AOG by the relative
position of the uterus in the abdominal cavity

IV. PHYSICAL
ASSESMENT
Measurements
& Vital Signs:
Height & Weight
Baseline vital signs & BP

Skin changes: choasma of face

Teeth & Gums: check for hypertrophy of gums (increased


vascularity)

Thyroid: symmetrical enlargement (R/O goiter)

Heart & Lungs: (In later stages of pregnancy):

PMI elevated & lateral in 3rd trimester


Non-pathological systolic flow murmurs develop
Diastolic murmur is always pathological

Breasts & Nipples: Note expected changes

Everted nipples indicate possible interference with breast


feeding

Discrete masses are considered pathological

Abdomen:

Contour

Skin changes: linea nigra, striae gravidarum

Fetal movement (felt by 24 weeks)

Uterine size & fundal height

Fetal Heart Rate (FHR): (120-160 per minute)

Fetal Heart Tones audible with Doppler, from 11-13 weeks


gestation

Genitalia
External genitalia & anus: lesions & varicosities
Vaginal leukorrhea
Adnexal areas: corpus luteum cyst-like
enlargement

COMMON SIGNS OF EARLY PREGNANCY

Extremities:

Varicosities

Edema
Leopolds Maneuver

Purpose: to estimate fetal size, locate fetal


parts and
determine presentation, position, engagement and attitude
LM1: fetal presentation
LM2: fetal position
LM3: fetal engagement
LM4: fetal attitude
Position: dorsal recumbent position
Preparation:
1. The client must empty her bladder 30 minutes
before examination;
2. Place a small pillow underneath the clients hips.

Ballottement fetus will bounce when lower uterine segment


is tapped sharply( on the 5th month )

Fetal Heart Rate Assessment

Stethoscope ( 18-20 weeks ) Expected Rate: 120-160 bpm

Pelvic Measurement are preferably doneafter the


6th lunar month. Xray Pelvimetry is the most
effective method of diagnosing cephalopelvic
disproportion. But since Xrays are teratogenic, the
procedure can be done only two weeks before EDC.

V. NUTRITIONAL
ASSESSMENT IN
Nutritional Assessment
PREGNANCY
Food preferences and eating habits

Cultural and religious influences


Education and occupational level

Weight Gain11.2 to 15.9 kg. ( 25 30 lb. )


recommended as an average weight gain in
pregnancy.
2 4 lbs. during 1st trimester
11 14 lbs. during 2nd trimester
8-11 lbs from the 3rd trimester