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Obstetrical Assessment

Gestation Time until the estimated date of confinement or estimated date of delivery About 280 days For Nageles Rule to be accurate requires that the woman have a regular 28-day menstrual cycle. Add 7 days to the 1st day of the last menstrual cycle period, substract3 months then add 1 year to that date

Gravity and Parity A.Gravidity

Gravida

refers to a pregnant woman Gravidity refers to the number of pregnancies Nulligravida is a woman who has never been pregnant Primigravida is a woman who is pregnant for the 1st time Multigravida is a woman in at least her second pregnancy

B.

Parity

Parity is the number of births (not the number of fetuses) past 20 weeks gestation, whether the fetus was born alive or not. Nullipara is a woman who has not had a birth at more than 20 weeks of gestation. Primipara is a woman who has had one birth that occurs after the 20th week of gestation. Multipara is a woman who has had two or more pregnancies resulting in viable offspring.

Pregnancy Signs
A.

Presumptive Signs Amenorrhea Nausea and vomiting Increased size and increased feeling of fullness in breasts Pronounced nipples Urinary frequency Quickening: The first perception of fetal movement may occur as early as the 14th 16th week of gestation

Probable Signs
Uterine enlargement Hegars sign: softening and thinning of the lower uterine segment that occurs about week 6 Goddells sign:softening of the cervix that occurs at the beginning of the 2nd month Chadwicks sign: bluish discoloration of the mucous membranes of the cervix, vagina and vulva that occurs week 6

Positive Signs
Fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by non-electronic device (fetoscope) at 20 weeks gestation Active fetal movements palpable by exmainer Outline of fetus via radiography or ultrasound

Fundal Height

Measured to evaluate the fetuss gestational age During the 2nd and 3rd trimesters Fundal height in centimeters approximately equals the fetuss age in weeks plus or minus 2 cm At 16 weeks, the fundus can be found halfway between the symphysis pubis and the umbilicus At 20 to 22 weeks , the fundus is at the umbilicus At 36 weeks, the fundus is at the xiphoid

Assessing Fetal Well Being

Fetal Movement
Quickening can be felt at approximately 18 to 20 weeks of pregnancy and peaks in intensity at 28 to 38 weeks Sandovsky Method the patient lie in a left recumbent position after a meal and record how may fetal movements she over the next hour. A fetus normally moves a minimum of twice every 10 minutes or an average of 10-12 times/hour

Cardiff Method
Count-to-ten method A woman records the time interval it takes for her to feel 10 fetal movements. Usually occurs within 60 minutes

Fetal Heart Rate

120 to 160 beats per minute Fetal heart sounds can be heard and counted as early as the 10th to 11th week of pregnancy by the use of ultrasonic Doppler Nonstress test measures the response of the fetal heart rate to fetal movement Usually done for 10 to 20 minutes When the fetus moves, the fetal heart rate should increase about 15 beats/min remain elevated for 15 seconds.

Biophysical Profile
Fetal Breathing Movements Fetal Body Movement Fetal Tone Fetal Reactivity Amniotic Fluid Volume

Discomforts of Pregnancy

A.

Nausea and vomiting Occur in the first trimester Due to elevated levels of hCG and changes in carbohydrate metabolism

1. 2. 3. 4.

Interventions: Eating dry crackers before arising Avoiding brushing teeth immediately after arising Drinking liquids between meals rather than at meals Avoiding fried foods and spicy foods

B. Syncope
Usually occurs in the first trimester; Supine hypotension occurs particularly in the 2nd and 3rd trimester Syncope may be triggered hormonally or caused by the increased blood volume, anemia, fatigue, sudden position changes or lying supine

Interventions
Sitting with the feet elevated 2. Changing positions slowly 3. Changing the position to the lateral recumbent to relieve the pressure of the uterus on the inferior vena cava
1.

C. Urinary Urgency and Frequency


Usually in the 1st and 3rd trimester Due to pressure of the uterus on the bladder Interventions: 1. Drinking 2 qt of fluid during the day 2. Limiting fluid intake in the evening 3. Voiding at regular intervals 4. Sleeping on the side at night 5. Performing Kegel exercises

D. Breast Tenderness
Can occur from the 1st through the 3rd trimesters Due to increased levels of estrogen and progesterone Interventions: 1. Encouraging wearing a supportive bra 2. Avoiding the use of soap on the nipples and areola to prevent drying

Increased Vaginal Discharge


Occur from the 1st through the 3rd trimesters Due to hyperplasia of vaginal mucosa and increased mucus production Interventions: 1. Proper cleansing and hygiene 2. Wearing cotton underwear 3. Avoiding douching

Heartburn
in the 2nd and the 3rd trimesters Results from increased progesterone levels, decreased gastrointestinal motility and esophageal reflux, and the displacement of the stomach by the enlarging fetus
Occurs

Interventions:
1.

2.
3. 4. 5. 6.

Eating small, frequent meals Sitting upright for 30 minutes following a meal Drinking milk between meals Avoiding fatty and spicy foods Performing tailor-sitting exercises Taking antacids only if recommended by the physician

Ankle Edema
Occurs in the 2nd and 3rd trimesters Results from vasodilation, venous stasis and increased venous pressure below the uterus Interventions: 1. Elevating the legs at least twice a day 2. Sleeping on the left side 3. Wearing supportive stockings 4. Avoiding sitting or standing in one position for long periods of time

Varicose Veins
Usually occur in the 2nd and 3rd trimesters Result from weakening walls of the veins or valves and venous congestion Interventions: 1. Elevating feet when sitting 2. Lying with the feet and hips elevated 3. Avoiding long periods of standing or sitting 4. Avoiding leg crossing 5. Moving about while standing to improve circulation

Hemorrhoids
Usually occur in the 2nd and 3rd trimesters Result from increased venous pressure and constipation Interventions: 1. Soaking in a warm sitz bath 2. Sitting on a soft pillow 3. Eating high-fiber foods and avoiding constipation 4. Drinking sufficient fluids 5. Increase exercise such as walking

Constipation
Occurs in the 2nd and 3rd trimesters Results from decreased intestinal motility, the displacement of the intestines and taking of iron supplements Interventions: 1. Eating high-fiber foods 2. Drinking sufficient fluids 3. Exercising regularly 4. Avoiding laxatives or enemas without first consulting with the physician

Backache
Occurs in the 2nd and 3rd trimesters Results from an exaggerated lumbosacral curve resulting from the enlarged uterus Interventions: 1. Encouraging rest 2. Using correct body mechanics and improving posture 3. Wearing low-heeled shoes 4. Performing pelvic rocking and abdominal breathing exercises

Leg Cramps
Occur in the 2nd and 3rd trimesters Result from an latered calciumphospohorus balance and pressure of the uterus on nerves or from fatigue Interventions; 1. Getting regular exercise, especially walking 2. Dorsiflexing the foot of the affected leg 3. Increasing calcium intake

Shortness of Breath and Dyspnea


Results from pressure on the diaphragm Interventions: 1. Allowing frequent rest periods 2. Sleeping with the head elevated or on the side 3. Avoiding overexertion 4. Performing tailor sitting exercises

Laboratory Tests
Blood Type and Rh Factor ABO typing is performed to determine the womans blood type Rh typing is done to determine the presence or absence of Rh antigen (Rh positive or Rh negative) If the client is Rh negative and has a negative antibody screen, the client will need repeat antibody screens and should receive Rh immune globulin at 28 weeks gestation.
A.

B.

Hemoglobin and Hematocrit Levels Will drop during gestation as a result of increased plasma volume An increase in the hematocrit level may indicate the development of pregnancy-induced hypertension A decrease in the hemoglobin level to less than 10g/dL or in the hematocrit level less than 30g/dL indicates anemia

Hepatitis B Surface Antigen


Testing for hepatitis antigens is recommended for all women because of the prevalence of the disease in the general population Vaccination for Hepatitis B antigen may be specifically indicated for the following: 1. Clients with previously undiagnosed jaundice or chronic liver disease 2. IV drug abusers 3. Clients with tattoos 4. Clients with history of blood transfusion

5.

6. 7.

Clients with histories of multiple episodes of sexually transmitted diseases Clients with histories of dialysis or renal transplantation Clients from households having hepatitis B-infected members or hemodialyis clients

Urinalysis and Urine Culture

A urine specimen for glucose and protein determinations should be obtained at every prenatal visit Glycosuria is a common result result of decreased renal threshold that occurs during pregnancy. White blood cells in the urine may indicate infection Ketonuria may result from insufficient food intake or vomiting Level of 2+ to 4+ protein in the urine may indicate infection or pregnancy-induced hypertension.