Pregnancy Assessment

Health History
Review of Systems

NURS 02 2nd Semester AY 2018-2019

Health History
Focus the initial prenatal visit on
 confirming the pregnancy
 assessing the health status of the mother
and any risks for complications,
 and counseling to ensure a healthy
pregnancy.

NURS 02 2nd Semester AY 2018-2019

Health History
Ask about the following topics:
 Confirmation of pregnancy.
 Has the patient had a confirmatory urine pregnancy
test, and when?
 When was her last menstrual period LMP)?
 Has an ultrasound been done to establish dates? Explain
that serum pregnancy tests are rarely required to
confirm pregnancy
 Symptoms of pregnancy.
 absence of menses, breast fullness or tenderness, or
vomiting, fatigue, and urinary frequency.
 Explain that serum or urine testing for beta human
chorionic gonadotropin (HCG) offers the best
confirmation of pregnancy.
NURS 02 2nd Semester AY 2018-2019
Health History
 Maternalconcerns and attitudes. Review
the mother’s feelings about the
pregnancy and whether she plans to
continue to term. Ask about any fears and
about support from the father.

NURS 02 2nd Semester AY 2018-2019

Health History
Past obstetric history.
 Ask about prior pregnancies and outcomes.
 any complications during past pregnancies,
including labor and delivery?
 had a premature or growth-retarded infant,
or a baby large for gestational age?
 Has there been a prior fetal demise?

NURS 02 2nd Semester AY 2018-2019

Health History
Risk factors for maternal and fetal health.
 use tobacco, alcohol, or illicit drugs
 any medications, over-the-counter drugs, or
herbal prescriptions
 any toxic exposures at work, home, or otherwise
 Is nutritional intake adequate, or at risk for
problems stemming from obesity
 social support network and income sources
 unusual sources of stress at home or work
 any history of physical abuse or domestic violence

NURS 02 2nd Semester AY 2018-2019

Health History
Family history of chronic illnesses or
genetically transmitted diseases: sickle cell
anemia, cystic fibrosis, muscular dystrophy,
and others.

Plans for breast-feeding. Education and

encouragement during pregnancy are
recommended.

NURS 02 2nd Semester AY 2018-2019

Health History
 Gestational age. Count the number of weeks and
days from the first day of the LMP. Counting this
menstrual age from the LMP– although biologically
distinct from the date of conception, it is the
standard means of calculating fetal age, yielding
an average pregnancy length of 40 weeks. Rarely,
the actual date of conception is known (as with in
vitro fertilization.) In these cases, use a conception
age, which is 2 weeks less than the menstrual age.
However, this number should never be used to
make clinical judgments that rely on the menstrual
age for standards of care.
NURS 02 2nd Semester AY 2018-2019
Health History
 Expected date of delivery (EDD). The expected
date of delivery is 40 weeks from the first date of
the LMP. Using Naegele’s rule, the EDD can be
estimated by taking the LMP, adding 7 days,
subtracting 3 months and adding 1 year.

Limitations on pregnancy dating. Patient recall of the

LMP is highly variable. The LMP can also be biased by
hormonal contraceptives or lengthy menstrual
cycles. Check LMP dating against physical exam
markers such as fundal height, clarifying
discrepancies against ultrasound evaluation.
NURS 02 2nd Semester AY 2018-2019
CALCULATING THE EDC
 NAEGEL’S RULE
LAST MENSTRUAL FORMULA EXAMPLE
PERIOD (LMP)
January to March + 9months 01 / 01 / 19 (January 1, 2019)
+ 7days + 09 + 07 _
10 / 08 / 19 (October 08, 2009)
April to December - 3months 06 / 25 / 18
+ 7days -03 + 07 + 01
+ 1year 03 / 32 / 19 or 04 / 01 / 19
(April 01, 2019)
FIGURE: The EDB wheel can be used to calculate the due date. To use it,
place the “last menses began” arrow on the date of the woman’s LMP. Then
read the EDB at the arrow labeled 40. In this case the LMP is September 8,
and the EDB is June 17.
Obstetric Terminology
 Gravida: Any pregnancy, regardless of
duration, includes the current pregnancy
 Parity: Birth after 20 weeks’ gestation;
infant may be born alive or dead
 TPAL
 T: Number of term infants born
 P: Number of preterm infants
 A: Number of pregnancies ending in either
spontaneous or therapeutic abortion
 L: Number of currently living children
 Diagnosis of pregnancy
 Gravida means pregnancies and Para means live
births.
 Gravida indicates the number of times the mother
has been pregnant, regardless of whether these
pregnancies were carried to term. A current
pregnancy, if any, is included in this count.
 Para indicates the number of viable (>20 wks) births.
Pregnancies consisting of multiples, such as twins or
triplets, count as ONE birth for the purpose of this
notation.
 Abortus is the number of pregnancies that
were lost for any reason, including induced
abortions or miscarriages. The abortus term is
sometimes dropped when no pregnancies
have been lost.
 Ex: Gravida4Para3(3003) Pregnancy Uterine
38-39 weeks Cephalic in Labor
 G2P1 (1001) PU 37 2/7 weeks Breech in Labor
 G5P3 (3013) PU 36 5/7 week Transverse in
Labor
 nulligravida gravida 0: no pregnancies

 primigravida gravida 1, G1: 1 pregnancy

 secundigravida gravida 2, G2: 2

pregnancies

 Multigravida, more than 2 pregnancies

 TPAL Terminology

TPAL terminology is a system used to

describe obstetrical history.
T — term births
P — preterm births (prior to 37 weeks
gestation)
A — abortions
L — living children
 Exercises:
A 33 y.o. woman came to RHU to have a
prenatal check up. Upon interviewing a
woman has 2 living children born as preterm
twins in her first pregnancy, had an
spontaneous abortion 2 years after the first
delivery and year after she had term
delivery. What is her OB score?
A 29y.o. primi gravid client had a postnatal visit 1
week after a term delivery. Both the mother & the
baby are healthy upon assessment. What is her OB
score?
 A 40 weeks multi gravid client rushed to the ER with
chief complaint of greenish vaginal discharge.
Upon interview, she had 3 term deliveries and 1 of
them died after 1 week due to sepsis and 1
premature and still living today. She was on active
labor, and upon IE, cervix is at 8cm dilated, station
+1. They brought her directly to the Labor Room.
After an hour, she delivered the baby but
admitted to the NICU. What is the OB score?
Prenatal Visits
CHN
 1st Visit
 ASAP before 4 months
 During the 1st trimester
 2nd Visit
 During the 2nd trimester
 3rd Visit
 During the 3rd trimester
 Every 2 weeks
 After the 8th month until delivery

NURS 02 2nd Semester AY 2018-2019

Prenatal Visits
OB
 Every 4 weeks through the 28th week
 Every 2 weeks through the 36th week\
 Every week until delivery

NURS 02 2nd Semester AY 2018-2019

Review of Systems
Structure and Function
(Normal Changes)
Heart
Increase in cardiac output,
maternal blood volume and
heart size
 Peripheral vascular system
 Physiologic anemia
 Dizziness and light-headedness
NURS 02 2nd Semester AY 2018-2019
Structure and Function
(Normal Changes)

 Peripheral vascular system

 Dependent edema; varicosities
 Swelling of the lower extremities
 Thrombophlebitis

NURS 02 2nd Semester AY 2018-2019

Structure and Function
(Normal Changes)
 Skin, hair, and nails
 Breasts and abdomen enlarge
 Striae gravidarum;
hyperpigmentation; spider nevi;
growth of hair and nails increase
 Excessive oiliness or dryness of
scalp; Softening and thinning of
nails

NURS 02 2nd Semester AY 2018-2019

Structure and Function
(Normal Changes)
Abdomen
Lower pelvic discomfort
Kidney infection; urinary
frequency; constipation
Ptyalism and pica
Maternal hypoglycemia;
hypoinsulinemia
NURS 02 2nd Semester AY 2018-2019
Structure and Function
(Normal Changes)

Genitalia
Uterusenlarges; lightening
Goodell's sign; Chadwick's sign
Hypertrophy of the glands
Increase in vaginal discharge

NURS 02 2nd Semester AY 2018-2019

Structure and Function
(Normal Changes)
Ears and hearing
Decrease in hearing; fullness
in ears; earaches
Mouth hypertrophy; epulis;
nasal “stuffiness’’; epistaxis;
vocal changes
NURS 02 2nd Semester AY 2018-2019
Structure and Function
(Normal Changes)

Thorax and lungs

Increase in the
anteroposterior and
transverse diameters
Respiratory pattern changes
Shortness of breath
NURS 02 2nd Semester AY 2018-2019
Structure and Function
(Normal Changes)
 Breasts
 Tingling sensations; tenderness;
enlargement of breast and
nipple; hyperpigmentation
 Enlargement: Montgomery
tubercles
 Prominence of superficial veins
 Striae; colostrum
NURS 02 2nd Semester AY 2018-2019
Structure and Function
(Normal Changes)

 Anusand rectum
 Constipation; hemorrhoids

NURS 02 2nd Semester AY 2018-2019

Structure and Function
(Normal Changes)
Musculoskeletal system
Spine curves forward - lordosis
Shoulders droop forward
Pelvic diameter larger
Gait changes
Backaches

NURS 02 2nd Semester AY 2018-2019

Structure and Function
(Normal Changes)

Neurologic system
Pain or tingling feeling in the
thigh
Carpal tunnel syndrome
Leg cramps
Dizziness and lightheadedness
NURS 02 2nd Semester AY 2018-2019
Review of System – 2nd Trimester
 Gums bleeding  Cramping
 Nose bleeding  Bleeding
 Constipation  Dysuria
 Fetal movement  Abnormal discharge
 pruritis
Review of Systems – 1st Trimester
 Nausea  Pain with urination
 Vomiting  Changes in discharge
 Headaches (amount, color, odor)
 Dizziness  Pruritis
 Cramping  Bleeding
 Urinary frequency
Review of Systems – 3rd Trimester
 Indigestion  Contractions
 Swelling  Bleeding
 Leg cramps  Calf pain
 Fetal movement  Headaches
 Difficulty sleeping  Epigastric pain
 Visual changes