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Prenatal Management (Part 4)

Prenatal management involves regular visits with increasing frequency as the pregnancy progresses. The initial visit establishes baseline data through medical history, exams, and screening for risk factors. Subsequent visits monitor vital signs, weight, fetal growth, development and position through fundal height, heart rate, and palpation. Estimates of gestational age, fetal weight and length are calculated using formulas based on last menstrual period and exam findings.

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Austine James Sabenicio Pantilo
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174 views17 pages

Prenatal Management (Part 4)

Prenatal management involves regular visits with increasing frequency as the pregnancy progresses. The initial visit establishes baseline data through medical history, exams, and screening for risk factors. Subsequent visits monitor vital signs, weight, fetal growth, development and position through fundal height, heart rate, and palpation. Estimates of gestational age, fetal weight and length are calculated using formulas based on last menstrual period and exam findings.

Uploaded by

Austine James Sabenicio Pantilo
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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PRENATAL

MANAGEMENT
PRENATAL MANAGEMENT

FIRST VISIT: as soon as the mother missed a


menstrual period when pregnancy is suspected.

SCHEDULE OF VISITS
• Once a month up to first 32 weeks
• Twice a month (every 2 weeks) from 32 to 36
weeks
• Four times a month (every week) from 36 to 40
weeks
CONDUCT OF INITIAL VISIT

Baseline Data Collection

• To serve as basis for comparison with


information gathered on subsequent visits.

• To screen for high-risk factors.


• Medical and Surgical History – past
illnesses and surgical procedures, current
drugs used

• Family History to detect illnesses or


conditions that are transmittable

• Current Problems – activities of daily living,


discomforts, danger signs
Initial and Subsequent Visits
Vital Signs

• Temperature: slight rise because of increased progesterone and


increased activity of the thyroid gland; not to reach 38°C.
• CR: Plus 10 to 15BPM
• RR: May tend to be rapid and deep (16/min., deeper) because of
progesterone’s influence on the respiratory center. Maximum increase
under normal conditions: 24/min at rest.
• BP: Tends to be hypotensive with supine position: vena caval
syndrome.
• Prevention: LLR. BP lowest in the second trimester. Elevated BP
reading, may indicate pregnancy-induced hypertension (PIH).
Weight is checked in every visit.

• Total weight gain: 20 to 25 lb., with average of 24 Ib.; upper limit: 25 to


35 Ib.
• First trimester: 1 Ib. per month which is 3 to 4 Ib. total
• Second trimester: 0.9 to 1 Ib. per week or about 10 to 12 Ib.
• Third trimester: 0.5 to 1 Ib. per week or about 8 to 11 Ib.
• The patterns of the weight gain are more important than the amount of
weight gain.
• Normal weight gain patterns contribute to health of mother and fetus.
• Failure to gain weight is an ominous sign.
• Weight is therefore a measure of health of a pregnant mother.
Uterine testing for albumin and sugar
• Sugar – ideally not more than 1+
• Albumin – negative

Fetal growth and development assessment


• Fundal height
• Fetal heart tones/fetal heart rate
• Abdominal palpitation – Leopold’s maneuver
• Quickening – first fetal movement, plus subsequent
mobility
Obstetrical History
Preceding pregnancies and perinatal
outcomes:

4-Point System: Past pregnancies and


perinatal outcomes (F/TPAL)
• F – number of full term births
• P – number of premature births
• A – number of abortions
• L – number of currently living children
5-Point System: the total number of
pregnancies (G) is the first number
(G/TFPAL)

• G – total number of pregnancies


• F – number of full term births
• P – number of premature births
• A – number of abortions
• L – number of currently living children
Terms Related to Pregnancy Status
Estimates in Pregnancy

EDC/EDD: expected data of confinement/expected data of delivery.

Naegele’s Rule Formula:


• Add 7 days to the first day of the last menstrual period (LMP), subtract 3
calendar months then add 1 year

Given LMP: May 20, 2020


5 20 2020
- 3 + 7 + ___1
2 27 2021

EDD: February 27, 2021


Mittendorf’s Rule Formula:
• First, identify the LMP woman’s race (Caucasian/white or
non-Caucasian), and gravidity [primigravida (G1) or
multigravida (G2) above]

• Formula for Caucasian/white women, first time pregnant


(G1):
• EDD = [LMP + 15 days] – 3 months
 
• Formula for non-Cuacasian/non-white, multigravida:
• EDD = [LMP + 10 days] – 3 months
Date of Quickening
• Primigravida: Date of Q + 4 months and 20 days = EDC
• Multigravida: Date of Q + 5 months and 4 days = EDC

Fundic height.
• At symphysis pubis: 12 weeks
• At umbilicus: 20 to 22 weeks
• At xiphoid process: 36 weeks
Age of Gestation:

McDonald’s Rule (used in second and third trimesters)


First take the fundic height (FH) in centimeter using a tape measure.
Measure the distance from the top of the symphysis pubis over the
curve of the abdomen to the top of the uterine fundus using a tape
measure.

Formula for estimating age of gestation in lunar months:


FH x 2
7
Formula for estimating age of gestation in lunar weeks:
FH x 8
7
Batholomew’s Rule of Fours – measures
age of gestation by determining the position
of the fundus in the abdominal cavity.
EFW: estimated fetal weight

Johnson’s Rule: needs fundic height measure in


cm

• If unengaged:
EFW in g = [FH – 11] x 155

• If engaged:
EFW in g = [FH – 12] x 155
EFL: estimated fetal length in cm; Haase’s
Rule

First five months of pregnancy: square the month.


• To square the month is to multiply it by itself:
• Example: How long is a three-month old fetus?
3 x 3 = 9 cm

For the second half of pregnancy:


• Multiply month by 5.
• Example: How long is a 7-month-old fetus?
7 x 5 = 35 cm

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