The document discusses several methods for estimating a pregnancy's expected date of delivery (EDD) and age of gestation (AOG), including:
- Naegele's rule, which subtracts 3 months and adds 7 days to the first day of the last menstrual period (LMP).
- Mittendorf's rule and its variations for primigravid and multigravid women.
- Quickening, fundal height measurements, and ultrasound can also estimate EDD and AOG when LMP is unknown.
- Various rules like McDonald's, Bartolomew's, and Johnson's use fundal height to calculate AOG and estimate fetal weight and length.
The document discusses several methods for estimating a pregnancy's expected date of delivery (EDD) and age of gestation (AOG), including:
- Naegele's rule, which subtracts 3 months and adds 7 days to the first day of the last menstrual period (LMP).
- Mittendorf's rule and its variations for primigravid and multigravid women.
- Quickening, fundal height measurements, and ultrasound can also estimate EDD and AOG when LMP is unknown.
- Various rules like McDonald's, Bartolomew's, and Johnson's use fundal height to calculate AOG and estimate fetal weight and length.
The document discusses several methods for estimating a pregnancy's expected date of delivery (EDD) and age of gestation (AOG), including:
- Naegele's rule, which subtracts 3 months and adds 7 days to the first day of the last menstrual period (LMP).
- Mittendorf's rule and its variations for primigravid and multigravid women.
- Quickening, fundal height measurements, and ultrasound can also estimate EDD and AOG when LMP is unknown.
- Various rules like McDonald's, Bartolomew's, and Johnson's use fundal height to calculate AOG and estimate fetal weight and length.
The document discusses several methods for estimating a pregnancy's expected date of delivery (EDD) and age of gestation (AOG), including:
- Naegele's rule, which subtracts 3 months and adds 7 days to the first day of the last menstrual period (LMP).
- Mittendorf's rule and its variations for primigravid and multigravid women.
- Quickening, fundal height measurements, and ultrasound can also estimate EDD and AOG when LMP is unknown.
- Various rules like McDonald's, Bartolomew's, and Johnson's use fundal height to calculate AOG and estimate fetal weight and length.
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Handout #11 5.
Ovulation that occurs after cessation of ovulation
EDD & AOG Computation inhibition method of contraception may be delayed
Naegele’s Rule: EXPECTED DATE OF DELIVERY & AGE OF GESTATION Inquire for last menstrual period (LMP) & Once pregnancy is confirmed, it is important to next calculate for expected date of determine the age of gestation & the expected date of delivery/confinement (EDD/EDC) delivery. Example: The clinically most appropriate unit of measure of Month Day Year gestational age is weeks of gestation completed. LMP 4 (April) 3 2004 Two methods used are the: -3 +7 +1 1. Menstrual age/Gestational age EDC 1 (Jan) 10 2005 Menstrual from LMP. The Naegele’s Rule: (Other way of Computation) average duration of pregnancy a. Determine the last normal LMP. using the menstrual age is 280 b. Consider the 1st day of the LMP. days. c. Consider the month in numeric terms. 2. Ovulatory age/Fertilization age eg. July – 7; August – 8 Measures from the date of For the 1st 3 months of the year, add 12 to the ovulation or fertilization. The numerical value average duration of pregnancy Eg. Jan. : 1 + 12 = 13 from ovulation is 267 days. Feb.: 2 + 12 = 14
March: 3 + 12 = 15 THE PARAMETERS THAT CAN BE USED TO ESTIMATE Naegele’s Rule: (Other way of Computation) EDC & MEASURE THE DURATION OF PREGNANCY ARE d. Now use Naegele’s formula: Subtract 3 months and THE FF: add 7 days to the 1st day of the LMP. A. Last Menstrual Period Example: LMP is March 5-10, 2008. The numerical value This involves calculating the length of time from of March is 3. the last menstrual period up to the present. 15 5 Problems encountered w/ the use of the LMP are the -3 following: 12 5 1. Failure to record LMP + 7 2. Menstrual cycles may be irregular & variable 12 12 EDD: Dec. 12 3. Pregnancy may follow immediately w/o menstruation Mittendorf’s Rule: in between gestation An alternative to Naegele’s Rule in determining the 4. Implantation bleeding may be mistaken as EDD. menstruation a. Determine the 1st day of the LMP. b. Categorize the woman as Caucasian or non- possible during pregnancy (age of gestation) for the Caucasian (race). client. c. Identify her gravidity: primigravida (G1) or The earlier the ultrasound is performed in pregnancy, multigravida (G2 or above) the more accurate is the EDC & AOG: Mittendorf’s Rule: 1st trimester ultrasound gives For primigravid Caucasian women: EDC +/- 5 days Formula: LMP + 15 days (constant) – 3 months = EDD 2nd trimester EDC +/- 10 days Example A: What is the EDD of Mrs. Smith, a G1 3rd trimester EDC +/- 3 weeks Caucasian w/ LMP of May 14? E. Assessment of Fundic Height M D Fundic height increases as the fetus inside the uterus 5 14 grows. - 3 + 15 Thus, it should be measured every visit to help 2 29 EDD: Feb 29 determine fetal growth. Mittendorf’s Rule: In addition, fundic height measurements will also help For multigravid non - Caucasian women: estimate AOG & EDC. Formula: LMP + 10 days (constant) – 3 months = EDD E. Assessment of Fundic Height Example B: What is the EDD of Mrs. Peralta, a G2 The landmarks to be used in measuring the FH are the Filipino woman (non-Caucasian) w/ LMP of Aug. 10? top of symphisis pubis, the umbilicus & the xiphoid. M D To ensure accuracy, the woman should empty her 8 10 bladder & the same examiner should perform the - 3 + 10 measurement at every examination. 5 20 EDD: May 20 F. MC DONALD’S RULE is used to calculate AOG C. Quickening: Quickening usually occurs at 20 weeks in Fundic height (cm) X 2/7 = AOG in lunar months primis & at 16 weeks in multis. Thus, if the woman Fundic height in (cm) X 8/7 = AOG in weeks cannot remember her LMP, ask her when she 1 st felt the G. MODIFIED MC DONALD’S RULE fetus move. Usually on the average of at least 10 times Simply remember the fundic height in cm. will per day. approximate the gestational age from 36-38 weeks +/- 3 To get EDC for primigravida, add 22 weeks to the date weeks of quickening H. BARTOLOMEW’S RULE is used to calculate AOG To get EDC for multigravida, add 24 weeks to the date Height of fundus is used to determine AOG. of quickening Fundic height is determined by palpation & by relating D. Ultrasound to the different landmarks in the abdomen: umbilicus, When a woman cannot accurately point out her last symphisis pubis, & xiphoid process. menstrual period, ultrasound must be made as early as H. BARTOLOMEW’S RULE is used to calculate AOG 12 weeks – level of symphisis pubis 16 weeks – halfway between umbilicus & symphisis Can be detected at 12 weeks of gestation with a pubis Doppler ultrasound 20 weeks – level of umbilicus Can be auscultated at 16 to 20 weeks with a fetoscope 24 weeks – 2 fingers above umbilicus Normal fetal heart rate (FHR) ranges from 120 to 160 28-30 weeks – halfway between umbilicus & xiphoid beats/minute process ----End--- 36 weeks – level of xiphoid process 40 weeks – at 34 weeks level due to lightening Greater Fundic Height May Indicate: Multiple pregnancy Miscalculated due date Polyhydramios Hydatidiform mole EXPECTED DATE OF DELIVERY & AGE OF GESTATION Fetal weight may vary & this is due to: Fetal weight may vary & this is due to: The age-weight pattern of previous infants An expected increase in weight of each successive infant Hereditary traits or acquired disorders may affect infant size. These factors include: race, nutrition, DM, preeclampsia, etc. I. JOHNSON’S RULE is used to calculate fetal weight in grams. Fundic height (cm) – N X K = fetal weight K = 155 (constant) N = 12 if engaged (do leopold’s to find out) N = 11 if not yet engaged J. HAASE’S RULE is used to determine length of fetus During the 1st half of pregnancy, square the number of months During the 2nd half of pregnancy, multiply the number of months by 5 K. Fetal Heart Sounds (rate)
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