ASSESSMENT ASSESSMENT IN IN PRE-NATAL VISITPRE-NATAL VISIT
MELBA GRACE T. DONIO, RNMELBA GRACE T. DONIO, RN
Prenatal Care Visit is a type of preventive healthcare with the goal of providing regular check-
ups that allow medical professionals to treat and prevent potential health
problems throughout the course of the pregnancy while
promoting healthy lifestyles that benefit both mother and child.
Maternal Health Program of the DOH
is tasked to reduced the maternal mortality ratio by three-quarters by 2015:MMR of 112/100,000 live births in 2010 MMR of 80/100,000 live births in 2015
Strategic Thrusts for 2005-2010
Launch and implement the Basic Emergency Obstetric Care or BEMOC. The BEMOC strategy entails the establishment of facilities that provide emergency care for every 125,000 population.
Improve the quality of prenatal and postnatal care
Reduce women’s exposure to health risks through the institutionalization of responsible parenthood and provision of appropriate health care package to all women of reproductive ages.
LGU’s, NGOs and other stakeholders must advocate for health through resource generation and allocation of health services for the mother and the unborn.
PRENATAL VISIT SCHEDULE
Schedule of first visit is as soon as the woman missed her menstrual period and pregnancy is suspected
1st trimester (1st 32 weeks): once a month 2nd (32-36 weeks): twice a month 3rd (36-40 weeks): every week
Assessment I. Obtain Biographical Data
a.MARITAL STATUS
b.OCCUPATION
c.RELIGION
d.CULTURAL BACGROUND
II. Health history
Menstrual history: menarche, regularity, frequency and duration of flow and last period.
Obstetrical history; all pregnancy, outcome, complication, contraceptives use, sexual history, type of birth
History of past illnesses
History of family illness
III. Current Health Problems
FORMULA USED TO ESTIMATE PREGNANCYDetermining the Last Menstual Period (LMP)First day of last menstruation
Determining the Expected date of delivery (EDC)
A. Naegele’s Rule
For LMP between April to December:
- 3 (months) +7 (days) +1 (Year)
For LMP betwen January to March:
+ 9 (months) +7 (days)
Determining the Age of Gestation (AOG)
Number of days since LMP to the present day divided by 7
B. Mc Donald’s Rule
Formula: AOG (months)= Fundic height (in cm)÷ 4
***For 20 weeks AOG and above:
FUNDIC HEIGHT (CM) = AOG (WEEKS)
**For below 20 weeks AOG:
= FH (CM) x 8 / 7
= AOG in weeks
C. Bartholomew’s Rule – estimates AOG by the relative position of the uterus in the abdominal cavity
AOG Anatomical Landmark: 12 weeks Slightly above the symphysis pubis 20 weeks Level of the umbilicus 36 weeks Below the xiphoid process 32 and 40 weeks Same level due to lightening on the
40th week
IV. PHYSICAL ASSESMENT Measurements & Vital Signs:
• Height & Weight
• Baseline vital signs & BP
Skin changes: choasma of face
Teeth & Gums: check for hypertrophy of gums (increased vascularity)
Thyroid: symmetrical enlargement (R/O goiter)
Heart & Lungs: (In later stages of pregnancy):
• PMI elevated & lateral in 3rd trimester
• Non-pathological systolic flow murmurs develop
• Diastolic murmur is always pathological
Breasts & Nipples: Note expected changes
• Everted nipples indicate possible interference with breast feeding
• Discrete masses are considered pathological
Abdomen:
• Contour
• Skin changes: linea nigra, striae gravidarum
• Fetal movement (felt by 24 weeks)
• Uterine size & fundal height
• Fetal Heart Rate (FHR): (120-160 per minute)
• Fetal Heart Tones audible with Doppler, from 11-13 weeks gestation
Genitalia
• External genitalia & anus: lesions & varicosities
• Vaginal leukorrhea
•Adnexal areas: corpus luteum cyst-like enlargement
COMMON SIGNS OF EARLY PREGNANCY
Sign Finding Gestational Age
Goodell softening of cervix 4-6 weeks
Hegar softening of uterine isthmus 6-8 weeks
McDonald fundus flexes easily on cervix 7-8 weeks
Chadwick bluish color or cervix,
Vagina & vulva 8-12 weeks
Extremities:
• Varicosities
• Edema
Leopold’s Maneuver
Purpose: to estimate fetal size, locate fetal parts and determine presentation, position, engagement and attitude
LM1: fetal presentation
LM2: fetal position
LM3: fetal engagement
LM4: fetal attitude
Position: dorsal recumbent position
Preparation:
1. The client must empty her bladder 30 minutes
before examination;
2. Place a small pillow underneath the client’s hips.
Ballottement – fetus will bounce when lower uterine segment is tapped sharply( on the 5th month )
Fetal Heart Rate Assessment
Doppler Ultrasound ( 10-12 weeks )
Stethoscope ( 18-20 weeks ) Expected Rate: 120-160 bpm
Pelvic Measurement are preferably done after the 6th lunar month. Xray Pelvimetry is the most effective method of diagnosing cephalopelvic disproportion. But since Xrays are teratogenic, the procedure can be done only two weeks before EDC.
V. NUTRITIONAL ASSESSMENT IN
PREGNANCY Nutritional Assessment Food preferences and eating habits Cultural and religious influences Education and occupational level
Weight Gain 11.2 to 15.9 kg. ( 25 – 30 lb. ) recommended as an average weight gain in pregnancy.
2 – 4 lbs. during 1st trimester 11 – 14 lbs. during 2nd trimester 8-11 lbs from the 3rd trimester