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Key points in Obstetrics and Gynecologic Nursing A

ssessment Formulas !

One of the most commonly asked concepts in obstetrics nursing is the use of appropriate formula for estimates in pregnancy consider the example below Ana had the first day of her last menstrual period on December 10 and the last day on December 15. She visits the clinic with a complaint of amenorrhea for three consecutive months. If indeed Ana is pregnant, the most probable expected date of confinement is: a. b. c. d. September 22 September 17 July 7 July 12

Now, let me tell you how to deal with this question. The first thing that you should consider is the kind of data given. Since the data which was given is the data of the last menstrual period (LMP), then it is expected that we use Nageles rule. According to this rule, the nurse should subtract 3 months and add seven days to the first day of the LMP to appropriately predict the expected date of confinement. So applying the formula, the answer is (B). Now lets simplify things. Below is table that summarizes the formulas used in providing estimates in pregnancy.

TABLE 1 Formulas used in providing estimates in pregnancy A. To estimate the EDC Given the
Last menstrual Period Date of quickening

Use
Nageles rule Date of quickening (Q)

Formula
First day of LMP subtract 3 months and then add 7 days Primigravida: Date of Q + 4 months + 20 days Multigravida: Date of Q + 5 + months + 4 days

B. To estimate the AOG

Given the
Fundic height

Use
McDonalds rule

Formula
Height in cm. Fundic Height in cm x 2 / 7 Fundic height in cm x 8 / 7 = duration in months = duration in weeks

Position the fundus in the abdominal cavity

Bartholomews rule of fours

Fundic height at the: Level of the xiphoid process = 9 months

Level of the umbilicus = 5 months Level of the symphyispubis = 1 month

C. Estimated Fetal Weight Given the


Rump-to-crown length in utero in cm.

Use
Standard formula

Formula
Rump-to-crown Length in uterus in cm x 100 = weight in gm FH (cms) - 11 (if unengaged) - 12 (if engaged) x 155 First 5 months = multiply the month by itself Second half of pregnancy = multiply month by 5

Johnsons Ruler

Age of gestation in month

Haases Rule

onvey appropriate information on Family Planning

Low-Dose Combined Oral Contraceptives - effective, reversible method - should be taken everyday - side effects: irregular vaginal bleeding, missed periods, upset stomach - protect against certain cancers, anemia and other conditions - not recommended for breastfeeding women because it can reduce milk supply - can be used for emergency contraception after unprotected sex DMPA (Depot medroxyprogesterone acetate) - effective and safe - changes in vaginal bleeding are normal - weight gain may occur - injection is done every 3 months - do not prevent STDs

do not contain estrogen

Norplant - capsules are placed under the skin of a womans upper arm - can prevent pregnancy for at least 5 years - can cause changes in menstrual bleeding, headache, heat tenderness, acne, weight gain, hair loss, more hair growth on the face - effective within 24 hours after insertion Tubal Ligation - permanent, effective - helps protect against ovarian cancer - reversal surgery is difficult - preparation of the patient for minilaparotomy or laparoscopy before: after: NPO for 8 hours no medications rest for 2-3 days avoid heavy lifting for a week take paracetamol avoid sex for at least 1 week

Reportable sign and symptoms: - high fever in the first 4 weeks - pain, pus, abdominal pain, diarrhea - fainting, dizziness Vasectomy - permanent - no effect on sexual performance - fully effective only after 20 ejaculations or 3 months. The man should use condoms or his partner should use another method. - common complications: pain in the scrotum, swelling, bruising, brief feeling of faintness after the procedure.

Condoms: - prevents pregnancy and STDs including HIV/AIDS - interrupts sex, reduces sensation - comes in different sizes, shapes, colors and textures - the only contraindication: LATEX allergy (severe redness, itching, swelling) IUDS - small flexible plastic frame - it is inserted into a womans uterus through her vagina - a provider can remove the IUD by pulling gently on the strings with forceps - common side-effects: menstrual changes (longer, heavier menstrual periods, bleeding and spotting, cramps or pain during periods - check the IUD once a week during the first month after insertion, after each menstrual period, if possible after noticing any possible symptoms of serious problems - to check the IUD, a woman should: wash her hands, sit in a squatting position, insert 1 or 2 fingers into her vagina as far as she can until she feels the strings. Do not pull on the strings - instruct the patient to return for a visit 3-6 weeks after IUD insertion Vaginal Methods (spermicide, diaphragm, cervical cap) - methods that women control and can be used when needed - helps protect against some STDs - insert spermicide up to 1 hour before sex. Place it high in the vagina. Insert foaming tablets, films, and suppositories at least 10 minutes before sex. Do not douche for at least 6 hours after sex - insert a diaphragm or cervical up ahead of time when you might have sex. After sex leave the diaphragm or cap in place and do not douche for at least 6 hours Fertility awareness-based methods - Remember the rules:

Cervical secretions: avoid unprotected sex from the first day of any cervical secretions or feelings of vaginal wetness until the 4th day after the peak day of slippery secretions Basal body temperature (BBT). Avoid unprotected sex from the first day if menstrual bleeding until body temperature has risen and stayed up for 3 full days Calendar or rhythm: Determine the fertile time through calendar calculations. Avoid unprotected sex between the first and last days of the estimated fertile time Cervical secretions + BBT. Avoid unprotected sex from the first day of cervical secretions until both the 4 th day after the peak of slippery secretions and the 3rd full day after the rise in body temperature.

LAM (Lactation Amennorhea Method) - temporary - based on breastfeeding - can be used when: (1) the woman breastfeeds often both day and night. (2) menstruation have not returned. (3) baby is less than 6 months. - effective for up to 6 months after childbirth - an ideal pattern of breastfeeding for LAM is at least 8-10 times a day including at least once a night.