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CARE OF MOTHER AND NEWBORN

(NORMAL PREGNANCY)

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` CALENDAR METHOD

Steps:

1.Keep a diary of six Menstrual cycles

2. Safe days: subtract cycle subtract 18 fromthe shortest ( this number represents her

first fertile day)

3. Subtract 11 from the longest cycle (this

represents her last fertile day

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First Day of Period Number of Days in Cycle

JAN. 20 29

FEB. 18 28

Mar. 18 29

Apr. 16 25

May 12 28

June 9 28

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` Find the shortest cycle in your record.

` Subtract 18 from the total number of days.

` Count that number of days from day one of

your current cycle, and mark that day with anX. Include day one when you count.

` The day marked X is your first fertile day.

` Ex. 25-18= 7 ( 1st fertile day)

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` Find the longest cycle in your record.

` Subtract 11 days from the total number ofdays.

` Count that number ofdays from day one of your

current cycle, and mark that day with an X. Include dayone when you count.

` The day marked X is the last fertile day.

` Ex. 29-11= 18 ( Last fertile day)

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` Here is an example:

` Predicting your first fertile day.

` If your shortest cycle is 25days long,

subtract 18 from 25. That leaves 7 If

day one was the 9th day of the month,

the day you will mark X will be the

14th. That's the first day you're likelyto be fertile. So on that day, you

should start abstaining from sex or

start using a cervical cap, condom,

diaphragm, or female condom.

` Predicting your last fertile day.

` If your longest cycle is 29days,

subtract 11 from 29. That leaves 18. If

day one was the 9th day of the month,

the day you will mark X will be the

26th. That's the last day you're likely to

be fertile during your current cycle. So

you may start to have unprotected

vaginal intercourse after that day.

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` First day of your last period.` Length of cycles, length ofperiod.` Periods regularity, shortest and longest times.` Severity increasing as timegoes on.` Spells ofno periods in absence ofpregnancy.` Periods heavy, clots, flooding.` Pads or tampons used,number required.` Periods painful.` Bleeding betweenperiods, after intercourse.`

Time of menarche,menopause.` If menopause: hot flushes,night sweats [assesses severity of

decreasingestrogen].` Bleeding beforepuberty, after menopause.

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` Definitions

` Gravidity is defined as the number of times that a

woman has been pregnant and Parity is defined as the

number of times that she has givenbirth to a fetuswith a gestational age of 24 weeks or more, regardless

of whether the child was born alive or was stillborn.

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` a woman who is described as "gravida 2,para 2"(sometimes abbreviated to G2 P2) has had twopregnancies and two deliveries after 24 weeks,

` a woman who is described as "gravida 2,para 0 " (G2P0) has had two pregnancies, neither of which survived toa gestational age of 24 weeks.

` If they are both currently pregnant again, these womenwould have the obstetric resum ofG3 P2 and G3 P0respectively.

` Sometimes a suffix is added to indicate the number ofmiscarriages or terminations a woman has had. So if thesecond woman had had two miscarriages, it couldbeannotated G3 P0+2.

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` A nulliparous woman (nullip) has not givenbirth previously (regardless ofoutcome).

` A primagravida is in her first pregnancy.

` A primiparous woman has givenbirth once. The term 'primip' is oftenusedinterchangeably with primagravida, although technically incorrect as a womandoes notbecome primiparous until she has delivered her baby.

`

A multigravida has been pregnant more than once.` A multiparous woman (multip) has givenbirth more than once.

` A grand multipara is a woman who has already delivered five or more infants whohave achieved a gestational age of 24 weeks or more, and such women are traditionallyconsidered to be at higher risk than the average in subsequent pregnancies.

` A grand multigravida has been pregnant five times or more.

` A great grand multipara has delivered seven or more infants beyond 24 weeks'gestation.

` Multiplepregnancies present a problem: a multiplegestation counts as asingleevent and a multiple birth should be interpreted as a singleparousevent

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` TPAL is one of the methods to provide a quick

overview of a female's obstetric history.Two other

methods oftenused are gravida/para and GPA.

` InTPAL, the T refers to term births (after 37 weeksgestation),

` the P refers to premature births,

` the A refers to abortions,

` and the L refers to living children.

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` A pregnant woman who carried one pregnancy to termwith a surviving infant; carried one pregnancy to 35 weekswith surviving twins; carried one pregnancy to 9 weeks asan ectopic (tubal) pregnancy; and has 3 living childrenwould have a TPAL annotation

` T1, P1,A1, L3. This could also be written as 1-1-1-3.` Note, the "abortions" number refers to the total number

of induced abortions and miscarriages or ectopicpregnancies.

` The term "GTPAL" is used when the TPAL is prefixedwith gravidity, and "GTPALM" when GTPAL is followedbynumber of multiple pregnancies.[2]

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` ((LMP + 7 days) - 3 months) = Expected Date

of Delivery

EX: ((April 1 + 7 days) - 3 months) = January 8

` This rule doesnt take into account the fact thatmany women are uncertain of the date of their last

menstrual period, not all women have 28 day cycles,

andnot all women ovulate onday 14 of their cycle.

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` In 1990, researchers (Mittendorf, et al) re-examined this issuefor modernAmerican women. Results indicated that, for first-time Caucasian moms, anaveragepregnancy lasts 274days from conception (approximately 288 days from the lastmenstrual period).

` This research and other studies also show us many other factorsinfluence the length of pregnancy, including: mothers age, weight,ethnicity, prenatal care, prenatal nutrition and smoking, numberof prior pregnancies, and more.

` Mittendorf shows an average pregnancy is 269 days for motherswhove givenbirth before. Non-Caucasian moms have

shorterpregnancies than Caucasian moms; for example,African-American women average 266 days.

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` Begin with the startingdate of the last menstrual

period.Add 15 days for first time Caucasian mom, or

add 10 days if youre non-white or this is not your first

baby. Then subtract 3 months.` ((LMP + 15 days) - 3 months) = Expected Date

of Delivery

` EX: ((April 1 + 15 days) - 3 months) = January

16

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` If everyone hadnormal, regular periods, every 28

days, and could remember exactly when their last

period was, and ovulation always occurred onday #14

of the menstrual cycle, thengestational agedetermination wouldbe easy. These assumptions,

however, are not always the case. In real life,

determininggestational age canbe challenging.

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` One way to approximate apregnancy's currentgestational age is to use atape measure to determinethe distance from the pubic

bone up over the top of theuterus to the very top. Thatdistance, measured incentimeters, isapproximately equal to theweeks ofgestation, fromabout mid-pregnancy untilnearly the end of pregnancy.

MacDonald's Rule(Cm of fundal height = weeks

gestation)

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` If a tape measure is unavailable,these rough guidelines canbeused:

` At 12 weeks, the uterus is justbarely palpable above the pubicbone, using only an abdominal

hand.` At 16 weeks, the top of the

uterus is 1/2 way between thepubic bone and the umbilicus.

` At 20-22 weeks, the top of theuterus is right at the umbilicus.

` At full term, the top of the uterusis at the level of the ribs. (xyphoidprocess).

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` Johnsons rule is used toestimate theweight of thefetus ingrams. To determinethis, a standard formula is

used.` Formula: fundic height in cm

n x k

` k is constant, it is always155

` n is 12 if the fetus isengaged. It is 11 if the fetusis not yet engaged.

` Example:

` A fundic height of 28 cm,and the fetus is notengaged.

` 28 cm 11 x 155 = 17 x155 = 2635 grams

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` Calculation of fetal

length in cm. for the

first 5 months,square

the month;` 6-10 months multiply by

5.

` 2x2=4 cm

` 7 mos.x5= 35cm