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