By

Mrs/ Hamdia Mohammed

Learning Objectives:

1- Identify the items of preconception assessment.

2- List the assessment elements during pregnancy.
3- Discuss how to diagnose the pregnancy.
4- Perform Leopold maneuver for pregnant
woman.
5- List five abnormalities when assess pregnant
woman.
 Preconception assessment
Preconception assessment including:
 Nutritional intake (e.g., sufficient intake of folic
acid).
 Life style (e.g., drinking and smoking habits).
 Woman’s health status.
 Identify any potential problems (e.g., ectopic
pregnancy).
 Identify the woman’s understanding and
expectations of conception, pregnancy, and
parenthood.
Assessment elements during pregnancy
Assessment elements during pregnancy including:
•Woman’s health status.
• Nutritional status as well as the well-being of the
fetus is important throughout pregnancy.
• Assess the woman’s physiologic adaptation and the
family’s psychological adaptation to pregnancy.
• Noting any abnormal findings.
• Physical findings are gained though health history.
• Physical assessment.
• Laboratory tests.
 Assessment childbearing client
Diagnosis of the pregnancy:
 Rapid serum pregnancy test.

 Presumptive, probable and positive signs of

pregnancy.

 Laboratory tests.
 Presumptive, probable and positive signs of
pregnancy
Time from Presumptive Probable Description
implantation finding finding
(weeks)
1 Serum Tests of blood serum
laboratory reveal the presence of
tests human chorionic
gonadotropin hormone
2 Breast Feeling of tenderness,
changes fullness, or tingling;
enlargement and
darkening of areola.
2 Nausea & Nausea or vomiting on
vomiting arising
Presumptive, probable and positive signs
of pregnancy
Signs and symptoms of pregnancy are
divided into three:
1. Presumptive signs (least predictive of
pregnancy), subjective and cannot be
assessed by examiner.
2. Probable signs ( can be documented by
examiner).
3. Positive signs are those which cannot be
mistaken for any other condition -- they are
considered absolute evidence of pregnancy.
Presumptive, probable and positive signs
of pregnancy
Time from Presumptive Probable finding Description
implantation finding
(weeks)
2 Amenorrhea Absence of
menstruation

3 Frequent Sense of having

urination to void
frequently
6 Chadwick’s sign Color change of
the vagina from
pink to
purplish-blue
(violet)
 Presumptive, probable and positive
signs of pregnancy
Time from Presumptive Probable Description
implantation finding finding
(weeks)
6 Goodell’s Softening of the cervix
sign

6 Hegar’s sign Softening of the lower

uterine segment

6 Sonographic Characteristic ring is

evidence of evident.
gestational
sac
 Presumptive, probable and positive
signs of pregnancy
Time from Presumptive Probable **Positive Description
implantation finding finding finding
(weeks)
8 Sonographic Fetal
evidence of outline can
fetal outline be seen and
measured
by
sonogram
10 - 12 Fetal heart Doppler
audible ultrasound
reveals
heart beat
 Presumptive, probable and positive
signs of pregnancy
Time from Presumptive Probable **Positive Description
implantation finding finding finding
(weeks)
12 Fatigue General feeling of
tiredness
12 Uterine Uterus can be
enlargement palpated over
symphysis pubis
16 Ballottement When lower
uterine segment is
tapped on a
bimanual
examination, the
fetus can be felt to
rise against
abdominal wall
 Presumptive, probable and positive signs of
pregnancy
Time from Presumptive Probable **Positive Description
implantation finding finding finding
(weeks)
18 Quickening Fetal movement
felt by woman
20 Fetal Fetal movement
movement felt can be palpated
by examiner through
abdomen
20 Braxton Hicks Periodic uterine
sign tightening
occurs.
20 Fetal outline Fetal outline can
felt by be palpated
 Presumptive, probable and positive
signs of pregnancy
Time from Presumptive Probable **Positive Description
implantation finding finding finding
(weeks)
24 Linea nigra Line of dark
pigment on
the abdomen
24 Melasma Dark pigment
on face.
24 Striae Red streaks
gravidarum on abdomen
 Assessment childbearing woman
Laboratory tests:

Detecting the presence of human chorionic

gonadotropin (HCG) in the
Urine
 blood

HCG appear in the serum as early as 24-48 hours after

implantation.
 Leopold’s Maneuver

• Four-part process
1. Determine the position of the baby in utero
2. Determine the expected presentation during
labor and delivery
 Preparation
• Woman is supine, head slightly elevated and
knees slightly flexed
• Place a small rolled towel under her right hip

– If the doctor is R handed, stand at the woman’s R

side facing her for the first 3 steps, then turn and
face her feet for the last step (L handed, left
side).
 First Maneuver
What part is in the fundus?
• Facing the mother, palpate the fundus with both
hands
– Assess for shape, size, consistency and mobility
Fetal head: firm, hard, and round
• Moves independently of the rest
• Detectable by ballotement
Buttocks/breech: softer and has bony
prominences
• Moves with the rest of the form
Fundal Palpation
 Second Maneuver
Determine position of the back.
• Still facing the mother, place both palms on the
abdomen
• Hold R hand still and with deep but gentle pressure, use
L hand to feel for the firm, smooth back
– Repeat using opposite hands
• Once located the back, confirm findings by palpating
the fetal extremities on the opposite side (“lumpy”)
Lateral Palpation
 Third Maneuver
Determine what part is lying above the inlet.

• Gently grasp just above symphisis pubis with the

thumb and fingers of the R hand
• Confirm presenting part (opposite of what’s in the
fundus)
– Head will feel firm
– Buttocks will feel softer and irregular
• If it’s not engaged, it may be gently pushed back and
forth
– Proceed to the 4th step if it’s not engaged…
Pawlik’s maneuver (gribs)
 Fourth Maneuver
Flexed/Deflexed/Extended?
• Turn to face the woman’s feet
• Move fingers of both hands gently down the sides of
the abdomen towards the pubis
• Palpate for the cephalic prominence (vertex)
– Prominence on the same side as the small parts
suggests that the head is flexed (optimum)
– Prominence on the same side as the back
suggests that the head is extended
Pelvic palpation
Abdominal gribs
 Pregnancy and the mouth
• Hypertrophy of the gums
• Increased vascularity
• Changes in salivary composition
• Increased plaque deposition
• Exposure to stomach acids (1st trimester)
• Loosening of teeth (3rd trimester)
 The mouth

• Angular cheilitis
– B vitamin
deficiency
– Fungal infections
– Over-biting
“Gingivitis of pregnancy”
 The mouth

• Mild aphthous
ulcer (AKA canker
sore)
– Viral, bacterial
– Stress
– Underlying
immune disease if
frequent
Cyanosis of nail beds
Edema