NURSING CARE DURING PRENATAL PERIOD • Formula: AOG (months)= Fundic

height (in cm)÷ 4

I. ASSESSMENT
E.g. FH of 24 cm
A. Nursing Health History = 24 ÷ 4
1. Estimation of EDC, AOG, LMP, FH, = 6 months (24 weeks)
Naegele’s Rule, Weight
***For 20 weeks AOG and above:
Determining the Last Menstual Period (LMP) FUNDIC HEIGHT (CM) = AOG (WEEKS)
 First day of last menstruation **For below 20 weeks AOG:
= FH (CM) x 8 / 7
Example: Last menstruation= = AOG in weeks
June 14-18, 2008
 Bartholomew’s Rule – estimates AOG
LMP: June 14, 2008 by the relative position of the uterus in the
abdominal cavity
Determining the Expected date of delivery (EDC)
Naegele’s Rule AOG Anatomical Landmark:
12 weeks Slightly above the symphysis pubis
 For LMP between April to December: 20 weeks Level of the umbilicus
- 3 (months) +7 (days) +1 (Year) 36 weeks Below the xiphoid process
32 and 40 weeks Same level due to lightening on the
 For LMP betwen January to March: 40th week
+ 9 (months) +7 (days)

Examples: 2. OB Classification:
1. LMP : January 15, 2005 Gravida; Para; Full term; Abortion
01 15 2005 Obstetrical Scoring (GP TPALM)
+ 9 +7
__________________
 Gravida- number of pregnancy
10 22 2005 (October 22, 2005)
(including present pregnancy)
2. LMP : December 16 2004  Parity- number of viable pregnancies who
are previously born/ number of viable deliveries
12 16 2004  Term- number of children born
-03 +7 +1 between 37- 42 weeks AOG
__________________  Preterm- number of children born
09 23 2005 before the 37th week of gestation
(September 23, 2005)  Abortion- pregnancy that did not
reach the age of viability (> 20 weeks AOG
Determining the Age of Gestation (AOG) or < 400g)
 Number of days since LMP to the  Living- number of CURRENTLY
present day divided by 7 living children
 Multiple Pregnancies- (i.e. twins,
Example: triplets are counted as one)
A pregnant woman comes to the clinic for an
initial prenatal check up. Her LMP was B. Physical Assessment
December 16, 2004. Present day is February 1. Leopold’s Maneuver
14, 2005. Purpose: to estimate fetal size, locate fetal parts
and determine presentation, position, engagement
December - 15 (31 days – 16 days) and attitude
January - 31 LM1: fetal presentation
February - 14 LM2: fetal position
______________________ LM3: fetal engagement
60 days / 7 = 8 weeks and 4 LM4: fetal attitude
days (AOG)
Position: dorsal recumbent position

 Mc Donald’s Rule
Preparation: 1. The client must empty her bladder
30 minutes before examination; 2. Place a small 2. Instruct the client not to void
pillow underneath the client’s hips. • Rationale: Fills
the urinary bladder and moves it
2. Vital signs (BP)/ Weight upward and away from the uterus;
3. Fetal assessment: FHR; Fetal Movement when the bladder is full, the examiner
Normal Fetal Heart Tone: 120-160 BPM can assess other structures, especially
Number of Fetal movement every 10 minutes: the vagina, cervix, in relation to the
2 for every 10 minutes bladder
Number of Fetal movement every hour:
10-12 per hour 3. Position: Supine
• If the client complains of
*DIAGNOSIS OF PREGNANCY dizziness or shortness of breath:
A. Place the patient on
STAGE PRESUMPTIVE PROBABLE POSITIVE side lying position with towel under
hip
First Amenorrhea Chadwick’s Ultrasound B. Elevate the patient’s
Trimester Morning signs evidence upper body during the test to
sickness Goodell’s sign PREVENT COMPRESSION OF
Breast changes Hegar’s sign VENA CAVA
Fatigue Positive HCG
Urinary (pregnancy Amniocentesis
frequency test)
Enlarging uterus Elevation of
BBT  It is a procedure used to obtain
amniotic fluid for testing
Second Quickening Enlarged Fetal heart tone
trimester Increased skin abdomen Fetal movement  The physician scans the uterus
pigmentation; Braxton Hicks felt by the using ultrasound to identify the fetal and
(chloasma and Contraction examiner placental positions to identify adequate
linea nigra) Ballotement Fetal outline on X-ray
amount of amniotic fluids.
Striae
gravidarum
 The skin is cleaned with betadine;
local anesthesia at the needle insertion is
optional; gauge 22 needle is then inserted
C. Laboratory tests into the uterine cavity and amniotic fluid is
Urine withdrawn.
Heat acetic- ALBUMINURIA
Benedict’s tests- GLYCOSURIA  Obtain 15-20 cc of amniotic fluid
Urinalysis- UTI for examination

Blood  Should not be done until at least 16

CBC (Hgb, Hct)- ANEMIA weeks of gestation
Blood typing
VDRL- SYPHILIS  A. Diagnostic Uses: Provides
information on
4. Diagnostic Tests 1. Fetal Health
• Assesses appropriate levels of:
Ultrasound a. Alpha- fetoprotein (AFP)
b. Human chorionic gonadotropin
 Intermittent ultrasonic waves are (HCG)
transmitted by an alternating current to a c. Unconjugated estriol (UE)
transducer, which is applied to the • Necessary for detection of
women’s abdomen DOWN SYNDROME (TRISOMY 21),
TRISOMY 18, and NEURAL TUBE
 Two types: DEFECT
A. Transabdominal
B. Transvaginal 2. Fetal lung maturity
• Assesses for:
 Nursing Responsibilities: a. Lecithin/ Sphingomyelin (L/S)
1. Drink 1- 1.5 quart of water 2 hours ratio-surfactant
before the procedure

**By 35 weeks AOG, the normal
L/S ratio= 2:1; decrease risk of
acquiring Respiratory Distress
Syndrome
b. Phosphatidylglycerol (PG)-
phospholipid in surfactant
**Appears when fetal lung maturity
has been attained at about 35
weeks AOG, must be present to
prevent RDS
3. Genetic disorders
 Nursing Responsibilities:
1. Monitor for the side effects:
• Unusual fetal hyperactivity or lack of
movement
• Clear vaginal discharge/ Bleeding
• Uterine contraction or abdominal
pain
• Fever or chills
2. Instruct to engage to LIGHT
ACTIVITY 24 HOURS after the test
• Rationale: to decrease uterine
irritability
3. Increase fluid intake
• Rationale: to increase utero-
placental circulation and replace
amniotic fluid
Contraction Stress Test (CST)
 Means of evaluating the respiratory
function (oxygen and carbon dioxide
exchange) of the placenta
 Identifies the fetus at risk for
intrauterine asphyxia by observing the
response of the FHR to the stress of
uterine contractions (spontaneous or
induced)
 Procedure
1.
The critical component of CST is the
presence of uterine contractions.
They may occur spontaneously or may
be induced with oxytocin administered
via IV (also known as oxytocin
challenge test). The natural way of
obtaining oxytocin is through nipple
stimulation.
2.
An electronic fetal monitor is used to
provide continuous data about the fetal
heart rate and uterine contractions.
3.
After 15 minutes of baseline recording
of uterine activity and FHR, the tracing
is evaluated for presence of
spontaneous contractions. If 3
spontaneous contractions of good
quality and lasting 40-60 seconds occur
in a 10 minute window, the results are
evaluated. If no contractions occur or
they are insufficient for interpretation,
oxytocin is administered via IV or the
breasts are stimulated.
 Interpretation
1. Negative
(normal/ desired result)
• 3 contractions of good quality
lasting 40 seconds or more in 10
minutes without evidence of late
decelerations
• Implies that the fetus can
handle the hypoxic stress of uterine
contractions
2. Positive
(Abnormal result)
• Repetitive late decelerations with
more than 50% of the contractions
• Implies that the hypoxic stress of
contraction causes a slowing of the
FHR
3. Equivocal/
Suspicious
• Non-persistent late decelerations or
decelerations associated with
hyper-stimulation (contractions
frequency every 2 minutes or
duration of longer than 90 seconds
Nonstress Test
 measures the response of the fetal heart
rate to fetal movement
 Instruct the mother to push the button
attached to uterine contraction monitor if
she feels the fetus moves
 Usually done for 10-20 minutes
 What happens to the FHT if fetal movement
occurs?
As the fetus moves, there is an
INCREASE in FHT (15 beats per minute)
and remains elevated for 15 seconds
 Results and Interpretation:
A. Reactive
 If two accelerations of FHR (15 beats or  Indication of BPP: (at risk of
more) lasting for 15 seconds occur after placental insufficiency or fetal compromise
fetal movement because of the following:
4. Intrauterine
B. Non reactive growth restriction (IUGR)
If no acceleration occurs with fetal 5. Maternal DM
movement or no fetal movement 6. Maternal heart
disease
7. Maternal
Biophysical Profile (BPP) chronic HPN/ Preeclampsia/ eclampsia
 Comprehensive assessment 8. Maternal
of five biophysical variables: sickle cell anemia
1. f 9. Suspected
etal breathing movement fetal post maturity
2. f 10. History of
etal movements of body or limbs previous still births
3. f 11. Rh
etal tone (extension or flexion of sensitization
extremities) 12. Abnormal
4. a estriol excretion
mniotic fluid volume (visualized as 13. Hypeethyroidi
pockets of fluids around the fetus) sm
5. r 14. Renal disease
eactive FHR with activity (reactive NST) 15. Nonreactive
NST
 The first 4 variables are
assessed by UTZ scanning. FHR reactivity Chorionic Villi Sampling
is assessed with the NST.  Invol
 Determines the ves obtaining a small sample of chorionic
compromised fetus or confirms the healthy villi from the developing placenta
fetus
 For
(Criteria for BPP Scoring) st
1 trimester diagnosis of genetic,
Component Normal (score= 2) Abnormal (score= 0) metabolic, and DNA studies
Fetal breathing ≥ 1 episode of ≤ 30 seconds of
rhythmic breathing breathing in 30  Can
movement lasting ≥ 30 seconds minutes
within 30 minutes be performed either transabdominally or
Fetal ≥ 3 discrete body or ≤ 2 movements in 30 transcervically
limb movements in minutes
movements of 30 minutes (episodes  Perfo
body or limbs of active continuous
movement
rmed between 10 and 12 weeks; thus it can
considered as single not detect neural tube defect
movement)
Fetal tone ≥ 1 episode of No movements or  Risk
extension of a fetal extension/flexion
extremity with return
of CVS include:
to flexion, or opening 6. F
or closing of hand ailure to obtain tissue
Amniotic fluid ≥ 2 accelerations of ≥ 0-1 acceleration in 20 7. R
15 beats/min for ≥ 15 minutes upture of membranes
volume seconds in 20
minutes 8. L
Non stress Test Single vertical pocket Largest single vertical eakage of amniotic fluid
> 2 cm pocket ≤ 2 cm 9. B
leeding
 A score of 2 is assigned to 10. I
each normal finding and 0 to each ntrauterine infection
abnormal one, for a maximum score of 10. 11. M
 Score of 8 (with normal aternal tissue contamination of the
amniotic fluid) and 10 are considered specimen
normal. 12. R
h alloimmunization
 13.
pontaneous abortion
II. Diagnosis
Wellness diagnosis
Knowledge Deficit
Altered Health Maintenance
Nutrition, less than required
III. Planning/ Implementation/ Evaluation
A. Nutrition – most important aspect
*Nutritional assessment is
based on
taking a diet history first:
1. food preferences/ eating
habits
2. cultural/religious
influences
3. occupation/educational
level
B. Prenatal Exercises
1. Tailor sitting
-stretches and strengthen perineal muscles;
increase circulation in the perineum; make
pelvic joints more pliable
2. Pelvic rock
-maintains good posture; relieves abdominal
pressure and low backache; strengthens
abdominal muscles following delivery
3. Squatting
-stretches the pelvic floor muscle; should be
done15 minutes daily
4. Pelvic Floor Contraction (Kegel’s)
-promotes perineal healing; relieves
congestion and discomfort in pelvic region;
tones up pelvic floor muscles `
5. Abdominal Contractions
-strengthens abdominal muscle during
pregnancy and prevents constipation
in the postpartal period
Walking is the best exercise during
pregnancy
Jogging is questionable because of the
strain of extra weight of pregnancy placed
on the knees
C. Hygiene
If membranes rupture or vaginal bleeding is
present or during the last month of
pregnancy, tub baths are contraindicated.
D. Travel
S Advise a woman who is taking a long trip by
automobile to plan for frequent rest or
stretch period
At least every 2 hours, she should get out of
the car and walk a short distance
Use of seat belt is advised (shoulder
harness and lap belts)
Infant car seat should be purchased
Traveling by plane is not contraindicated as
long as plane is pressurized. If more than 7
months, traveling by plane is not
recommended.
F. Immunization –Tetanus Toxoid
G. Nutritional Supplement
1. Folic acid
2. Iron
H. Managing Discomforts of Pregnancy
G. Clothing
Use of abdominal support such as light
maternity girdle for support not to compress
and constrict the abdomen
Avoid knee high stockings
H. Sexual Activity
Contraindicated:
1. Women with history of abortion
2. Rupture membrane
3. Vaginal spotting
I. Prenatal visit
Start of pregnancy – 32 weeks
Every month
On 32-36 weeks AOG
Every 2 weeks/twice a month
On 36 weeks AOG
Every week until labor pains set in