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In
Pregnancy
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Members:
Ayes, Monique
Cabiltes, Claitte
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ASSESSMENT in PREGNANCY
I. Definition of Terms:
1. Pregnancy
2. Antepartum
3. Gestation
1. McDonald’s Rule
2. Naegele’s Rule
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I. DEFINITION OF TERMS:
• Antenatal Care – is the routine care that all healthy women can
expect to receive during their pregnancy. Ensuring the overall
health of newborns and their mothers and helping to reduce the
low-birthweight babies born each year.
• Last Menstrual Period – Refers to the first day of your last period
before conception occurred. Is used to calculate the baby's due
date.
• Age of Gestation – it is the time measured from the first day of the
woman's last menstrual cycle to the current date. It is measured in
weeks. A normal pregnancy can range from 38 to 42 weeks.
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based on the first day of a woman's last menstruation. Is also
called Estimated Date of Delivery or Estimated Due Date (EDD).
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II. PRENATAL MATERNAL ASSESSMENT
(Review of Systems)
Gallbladder
• Acid production in the stomach is decreased
• Effect of progesterone on smooth muscle also
decreases the tone and motility
• The cholesterol in the bile of the pregnant woman
Liver is more likely to crystallize.
• The liver is not
inflamed; not painful • Physically displaced by the enlarging uterus.
to touch and may feel
like a firm rectangular
ridge. Often it is not
palpable and you feel
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nothing firm.
Musculoskeletal • Head position is • The thyroid gland may increase in size after
System centered in the approximately 12 weeks of gestation (although
midline, and the studies are conflicting as t o whether or not there
accessory muscles is and increase) related to the increase in
should be vascularity. This may result in a shift in thyroid
symmetrical.
tests.
• The torso and head are
• Widening of smphysis pubis at approximately 28-
upright; walking is
initiated in one smooth 32 bbecause of hormones relaxin and
rhythmic fashion. progesterone affects all joints in the pregnant
• Muscle shape maybe woman’s body
accentuated in certain • Increased pelvic mobility to accommodate vaginal
body areas such as delivery
limbs and upper torso
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but should be • Developing lordosis of the lumbar spine that
symmetrical and it would keeps the center of gravity over the legs
should feel smooth • Leg weakness
and firm.
• There is no involuntary
• Developing of muscle cramps, particularly in the
muscle movement. calves,Thighs and buttocks especially at night
• Normal muscle • Increase of shoe size as much as full size as
strength allows for pregnancy progresses because of edema and
complete voluntary relaxation foot joints.
range of joint motion • Increased of fat deposits throughout the body.
against both gravity
and moderate to full
resistance.
Neurological System • No unusual frequent • Headaches
or severe headaches, • Numbness and tingling
no head injury, • Seizure activity with no prior history may indicate
dizziness or vertigo,
seizures or tremors.
the delopment eclampsia, or seizures associated
• No weakness, with pregnancy- induced hypertension.
numbness, or tingling • Dizziness and lightheadedness may due to the
or difficulty fetus pressure on the vena cava.
inspeaking. • Lapses of memory and etiology is poorly
understood
Reproductive Organ • The skin over the • Enlarging uterus
mons pubis should be • The round and broad ligaments elongate to
clear except for nevi accommodate the growing fetus and may cause
and normal hair
the patient lower quadrant pain
distribution.
• Decrease fundal height ( lightening) it is due to
• Labia majora and
minora should appear the descent of the presenting of the fetal part into
symmetrical with a the pelvis
smooth to somewhat • Cervix experiences increases vascularity and
wrinkled, unbroken, increased friability or susceptibility to bleeding
slightly pigmented • Vaginal discharge increases and is typically of a
surface. white consistency.
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• There should be no
ecchymosis cyst,
excoriation, nodules,
Breasts swelling, rash or • Breast changes may include enlargement,
lesions. tingling and tenderness secondary to hormonal
• Clitoris is 2cm in
changes.
length and .5cm in
• The areolae may darken. The nipples may
diameter without
lesions. The urethral become darker and more erect.
opening is slitlike in • Colustrum, a thick, yellow discharge known as
appearance and early brest milk, maybe secreted as early as the
midline; it is free of 2nd trimester.
discharge, swelling or • Veins in the breast may become more apparent
redness and is about and blue as they become engorged from
the size of a pea. increased vascularization.
Normal vaginal
discharge is clear to
white and free of foul
Anus and Rectum odor.
• Common to have a • Decrease gas through intestinal tract tone and
slight asymmetry in mobility
size; often the left • Development of hemorrhoids
breast is slightly larger
than the right.
• The anal mucosa is
deeply pigmented,
coarse, moist and
hairless. It should be
free of lesions,
inflammation, rashes,
masses or additional
openings.
• The anal opening
should be closed and
no leakage of feces or
mucus from the anus.
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• The rectum should
accommodate the
index finger, there
should be good
sphincter tone at rest
with bearing down.
Hematological System • • Increase white blood cells
• Increase total red blood cells volume
• Increase plasma volume
• Decrease number and increase size of platelets
• Increase fibrinogen and clotting factors VI-X.
Endocrine System • • Increase oxygen consumption and to fetal
metabolic demands may often lead to feeling of
warmth and hest tolerance
Renal System • • Increase glumerular filtration rate and renal
plasma flow
• Increase urinary output and decreases edema
• The woman’s kidneys must manage the increase
metabolic and circulatory demands of the,
maternal body and the excretion of fetal waste
product.
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III. IDENTIFY ALTERNATIVES IN COMPUTING FOR AOG &
EDC
A. NAEGELE’S RULE
(Expected date of confinement)
Formula:
(1st day of LMP) + 7 days – 3 months + 1 year
Note:
- January to March 24 (Add 12 to months)
- March 25 – December (add 1 to the year)
B.MCDONALD’S RULE
(Estimation of the duration of the pregnancy)
FORMULA:
# of cm x 8/7 = wks gestation
# of cm x 2/7 = duration of pregnancy in months
Note: inaccurate in 3rd trimester
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IV. COMPUTATION OF AGE OF GESTATION (AOG)
(TINAMBAN STYLE)
For Example:
Last menstrual period (LMP): September 7-12, 2008
Assessment date: April 21, 2009
LMP: September: 30
- 7
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September : 23
October : 31
November : 30
December : 31
January : 31
February : 28
March : 31
April : 21
226
AOG:
__32_r.2
7│226
21
16
14
2
__8_
4│32
32
x
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