CARE OF MOTHER AND NEWBORN (NORMAL PREGNANCY)

SKILLS LABORATORY

CALENDAR METHOD Steps: 1. Keep a diary of six Menstrual cycles 2. Safe days: subtract cycle subtract 18 from the shortest ( this number represents her first fertile day) 3. Subtract 11 from the longest cycle (this represents her last fertile day

First Day of Period

Number of Days in Cycle

JAN. 20 FEB. 18 Mar. 18 Apr. 16 May 12

29 28 29 25 28

June 9

28

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 an X. Include day one when you count. The day marked X is your first fertile day. Ex. 25-18= 7 ( 1st fertile day)

Find the longest cycle in your record. Subtract 11 days from the total number of days. Count that number of days from day one of your current cycle, and mark that day with an X. Include day one when you count. The day marked X is the last fertile day. Ex. 29-11= 18 ( Last fertile day)

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 likely to 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.

First day of your last period. Length of cycles, length of period. Periods regularity, shortest and longest times. Severity increasing as time goes on. Spells of no periods in absence of pregnancy. Periods heavy, clots, flooding. Pads or tampons used, number required. Periods painful. Bleeding between periods, after intercourse. Time of menarche, menopause. If menopause: hot flushes, night sweats [assesses severity of decreasing estrogen]. Bleeding before puberty, after menopause.

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 given birth to a fetus with a gestational age of 24 weeks or more, regardless of whether the child was born alive or was stillborn.

a woman who is described as "gravida 2, para 2" (sometimes abbreviated to G2 P2) has had two pregnancies and two deliveries after 24 weeks, a woman who is described as "gravida 2, para 0 " (G2 P0) has had two pregnancies, neither of which survived to a gestational age of 24 weeks. If they are both currently pregnant again, these women would have the obstetric resum of G3 P2 and G3 P0 respectively. Sometimes a suffix is added to indicate the number of miscarriages or terminations a woman has had. So if the second woman had had two miscarriages, it could be annotated G3 P0+2.

A nulliparous woman (nullip) has not given birth previously (regardless of outcome). A primagravida is in her first pregnancy. A primiparous woman has given birth once. The term 'primip' is often used interchangeably with primagravida, although technically incorrect as a woman does not become primiparous until she has delivered her baby. A multigravida has been pregnant more than once. A multiparous woman (multip) has given birth more than once. A grand multipara is a woman who has already delivered five or more infants who have achieved a gestational age of 24 weeks or more, and such women are traditionally considered 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. Multiple pregnancies present a problem: a multiple gestation counts as a single event and a multiple birth should be interpreted as a single parous event

TPAL is one of the methods to provide a quick overview of a female's obstetric history. Two other methods often used are gravida/para and GPA. In TPAL, the T refers to term births (after 37 weeks gestation), the P refers to premature births, the A refers to abortions, and the L refers to living children.

A pregnant woman who carried one pregnancy to term with a surviving infant; carried one pregnancy to 35 weeks with surviving twins; carried one pregnancy to 9 weeks as an ectopic (tubal) pregnancy; and has 3 living children would 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 ectopic pregnancies. The term "GTPAL" is used when the TPAL is prefixed with gravidity, and "GTPALM" when GTPAL is followed by number of multiple pregnancies.[2]

Naegeles Rule The standard calculation is called Ngeles Rule. This was developed in the 1850s by a Dr. Ngele, who determined that the average human pregnancy was 266 days from conception, or 280 days (40 weeks) from the start of the last menstrual period. To calculate this, begin with the first day of your last period (LMP). Add 7 days, then subtract 3 months.

((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 that many women are uncertain of the date of their last menstrual period, not all women have 28 day cycles, and not all women ovulate on day 14 of their cycle.

In 1990, researchers (Mittendorf, et al) reexamined this issue for modern American women. Results indicated that, for first-time Caucasian moms, an average pregnancy lasts 274 days from conception (approximately 288 days from the last menstrual period). Mittendorf shows an average pregnancy is 269 days for mothers whove given birth before. NonCaucasian moms have shorter pregnancies than Caucasian moms; for example, AfricanAmerican women average 266 days.

Begin with the starting date 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

If everyone had normal, regular periods, every 28 days, and could remember exactly when their last period was, and ovulation always occurred on day #14 of the menstrual cycle, then gestational age determination would be easy. These assumptions, however, are not always the case. In real life, determining gestational age can be challenging.

One way to approximate a pregnancy's current gestational age is to use a tape measure to determine the distance from the pubic bone up over the top of the uterus to the very top. That distance, measured in centimeters, is approximately equal to the weeks of gestation, from about midpregnancy until nearly the end of pregnancy.

MacDonald's Rule (Cm of fundal height = weeks gestation)

Ht. fundus/4 (AOG) Measure in cms. The length from the symphysis to the level of fundus Lunar months: Funadal height (cms) x2/7 Weeks of pregnancy: Fundal height (cms)x8/7

Example Fundal Ht. 14cms Lunar mos. 14cms.x2=28/7 =4 Weeks pregnant 14cmsx8=112/7=16 weeks AOG

If a tape measure is unavailable, these rough guidelines can be used: At 12 weeks, the uterus is just barely palpable above the pubic bone, using only an abdominal hand. At 16 weeks, the top of the uterus is 1/2 way between the pubic bone and the umbilicus. At 20-22 weeks, the top of the uterus is right at the umbilicus. At full term, the top of the uterus is at the level of the ribs. (xyphoid process).

Johnsons rule is used to estimate the weight of the fetus in grams. To determine this, a standard formula is used. Formula: fundic height in cm n x k k is constant, it is always 155 n is 12 if the fetus is engaged. It is 11 if the fetus is not yet engaged.

Example: A fundic height of 28 cm, and the fetus is not engaged. 28 cm 11 x 155 = 17 x 155 = 2635 grams

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