NC 101

Pregnancy Assessment
Pregnancy Assessment
 Pregnancy, also known as gestation, - is the
time during which one or more offspring
develops inside a woman. ...
 Symptoms of early pregnancy may
include missed periods,
tender breasts,
nausea and vomiting,
hunger, and
frequent urination.
 Pregnancy may be confirmed with a pregnancy
test
 Before
beginning an assessment, it is
essential to know the terms that are
unique to maternity nursing.
Definition of terms
 Gestation – the development of the new
individual within the uterus, from
conception to birth.
 Abdominal Gestation – development of

the fertilized ovum in the abdominal cavity

 Ectopic gestation - development of the

fertilized ovum outside the uterine cavity

(ectopic pregnancy).
 Tubular gestation – tubal pregnancy
 Gravida – a woman who is or has been
pregnant, regardless of the duration of the
pregnancy
 Primigravida – a woman who is pregnant

for the first time.

 Multigravida – a woman who has been

pregnant more than once

 Nulligravida – a woman who has never

been pregnant and is not currently pregnant

 Para – number of pregnancies that have
progressed past 20 weeks.
 The term does not indicate whether the

fetus was born alive or was stillborn.

 Parity does not reflect the number of

fetuses or infants
 A multiple gestation (twins, triplets, etc.) is

considered to be one parous experience.

 Nullipara – a woman who has never
completed a pregnancy beyond 20 weeks of
gestation
 Primipara – a woman who has given birth

after a pregnancy of at least 20 weeks of

gestation.
 Multipara - a woman who has given birth

two or more times at more than 20 weeks of

gestation
 Abortion – this refers to spontaneous or
elective termination of pregnancy before
the 20th week of gestation, based on the
date of the last menstrual period (LMP).
 Spontaneous abortion is frequently termed

“miscarriage” by the lay public.

 Term – a delivery that occurs between the
38th and 42nd weeks of gestation
 Preterm – a delivery that occurs after the

20th week and before the start of the 38th

week of gestation
 Postterm - a delivery that occurs after 42

weeks of gestation
 Trimester – a division of pregnancy into

three equal parts of 13 weeks each

 It is essential to know how to calculate
gravida and para; however,
 Incomplete information is obtained when

only gravida and para are counted.

Calculating gravida and
para
 A useful method for calculating gravida and
para is to divide “para” into number of Term
pregnancies, Preterm pregnancies,
Abortions, and Living children.
 The acronym “TPAL” is helpful

T = Term
P = Preterm
A = Abortions
L = Living children
 A more comprehensive system for
classifying pregnancy status: (GTPAL or
GTPALM) provides greater detail on a
woman’s pregnancy history.
 By this system, the gravida classification

remains the same, but the para is broken

down to: TPAL or TPALM
 Example:
 A woman who has had two previous

pregnancies, has given birth to two term

children, and is again pregnant is gravida 3,
para 2
 Using GTPAL system: would be:
 Gravida 3, para 2002 or 320020 (GTPALM)
 Multigestation pregnancy is considered as

one para
 Example:
 A woman who had term twins, then one

preterm infant, and is now pregnant again

would be a gravida 3, para 21031 (GTPALM)
Exercises:
 A woman who has had 2 miscarriages at 12
weeks (under the age of viability) and is
again pregnant is a gravida 3, para 0
 Using GTPAL system, would be: ????
Exercises:
 Example:
 A pregnant woman who had the following

past history – a boy born at 39 weeks’

gestation, now alive and well; a girl born at
40 weeks’ gestation, now alive and well; a
girl born at 33 weeks’ gestation, now alive
and well, what would be the woman’s
pregnancy information?
 Answer:
 Pregnancy information would be:
 Gravida 4; para 21030 (GTPALM)
 The following examples illustrate how to use
this method (TPAL) to obtain complete
obstetrical information (OB Score).
 A. Marian Dantes gave birth to twins at 36

weeks; she gave birth to a stillborn infant at

24 weeks; 2 years later, she suffered a
spontaneous abortion at 12 weeks. If
pregnant now, what would be her OB
information?
 Answer:
 Gravida 4, para 2
 T = 0, P = 3, A = 1, L = 2
 The birth at 24 weeks is counted in the

para, although the infant was stillborn.

 The termination of pregnancy before 20

weeks is counted in the gravida but not in

the para.
 The twins are counted as one pregnancy

and one delivery.

 B. Clara Villa is pregnant for the fifth time.
She had two elective abortions in the first
trimester; she has a son who was born at 40
weeks of gestation and a daughter who was
born at 36 weeks.
 Complete the OB information using the

acronym “TPAL” and explain.

 Answer:
 She is gravida 5, para 2.
 T = 1, P = 1, A = 2, L = 2
 The 2 abortions are counted in the gravida

but are not included in the para because

they occurred before 20 weeks.
 The daughter born at 36 weeks is preterm.
 A thorough history as well as a thorough
physical examination must be completed at
the first ante-partum visit.
 Although each agency has its own specific

forms, the forms differ only in format

because both medical and nursing practice
are governed by standards and similar data
are obtained by all agencies.
 The essential information that must be

obtained is called data base assessment.

Objectives of ante-partal examination:
 Verify or rule out pregnancy
 Evaluate the pregnant woman’s physical

health relevant to childbearing

 Assess the growth and health of the fetus
 Establish baseline data for comparison with

future observations
 Establish trust and rapport with the

childbearing family
 Evaluate the psychosocial needs of the
woman and her family
 Assess the need for counseling or teaching
 Negotiate a plan of care to ensure a healthy

mother and a healthy baby

Terminologies
 AOG – Age of Gestation/ age of the pregnant
uterus
 EDC/EDD – Expected Date of Confinement/

Expected Date of Delivery

 LMP – Last Menstrual Period/ First day of the

last menstrual period

 Quickening – the first-time life or fetal

movement is felt by the

mother
 OB Score – pregnancy information (F – Full

term, P = premature, A = abortions, L=

living
 Obstetric History
 This provide essential information about

prior pregnancies that may alert the

physician or nurse-midwife to possible
problems in the present pregnancy.
 Menstrual History
 A complete menstrual history is necessary

to establish the EDD

 It is a common practice to estimate the EDD

based on the first day of the last

menstruation cycle, although ovulation and
conception occur approximately 2 weeks
after the beginning of menstruation
 Most women consider themselves 1 month
pregnant at the time of the first missed
menstrual period, 2 months pregnant at the
second and so on…
 Since conception does not take place until

ovulation, 14 days after the onset of

menstruation in a 28-day cycle, it is obvious
that an embryo does not attain the age of
one month until about a fortnight after the
first missed period
 The age of a pregnancy in “months” the
physicians refer to “Lunar months”, that
is, period of 4 weeks.
 Since lunar months corresponds to the

usual length of the menstrual cycle

 The average duration of pregnancy from
the first day of the last normal menstrual
period (LNMP or LMP) is 40 weeks, or 280
days
Computation of EDC
A. Naegele’s rule is often used to establish
EDD/EDC
 To use this method:
 Subtract 3 months, and add 7 days to the

first day of the last normal menstrual period

(LNMP) and correct the year
 Example:
 LNMP/LMP –October 20, 2015
 Subtract 3 months = 10-3 = 7 (July)
 Add 7 days to day of LMP = 20+7 = 27
 add 1 year, EDC is July 27, 2016
 Example:
 LNMP/LMP – July 15, 2015
 Subtract 3 months = 7-3 = 4 (April)
 Add 7 days and correct the year = 15 + 7 =

22
 add 1 year, EDC is April 22, 2016
 Exercises:
 1. LMP – September 10, 1988
 2. LMP – April 15, 1950
 3. LMP – March 4, 1990
 4. LMP – Feb. 7, 2002
 5. LMP – January 30, 2014
 If menstrual cycle is irregular and the LMP is
between April to December of the year,
certain modifications are done in the
calculation.
 Steps Example

1. Obtain the LMP July 15, 2001

2. Ask the usual number of 33 (menstrual cycle) – 28 days

days of the menstrual cycle. = 5 days
Obtain the difference from 28
days
3. Add to day of LMP the 15 + 5 + 7 = 27
difference in the days obtained
in step 2 plus 7 days
4. Count 3 months back from 7 – 3 = 4 (April)
the month of LMP

5. Add 1 year. The EDC is April 27, 2002

Computation of EDC
B. Quickening
 For multigravida it occurs at the 16th to 18th

week of pregnancy while for the

primigravida it occurs at 18th to 20th week
 To estimate EDC for primigravida, 22 weeks

(5.5 months) are added to the date when

quickening was felt and for the
multigravida, 24 weeks (6 months) are
added instead.
 For practical reasons, it is suggested to add

6 months to the date of quickening

 Steps Example

1. Obtain date during which July 31, 2001

quickening was felt

2. Add 6 months to month of July ( + 6 moths = January)

Quickening

3. EDC is January, 2002

Fundic Height
Measurement
 The uterus should grow about 1 cm every
week, or 4 cm every month.
 Lay a cloth or soft plastic measuring tape on

the mother's abdomen, holding the 0 (zero)

on the tape at the top of the pubic bone
 Follow the curve of her abdomen, and hold

the tape at the top of her uterus

 The point of this measurement is to assess

baby’s size, growth rate, and position.

 C. Fundal Height
 Fundus becomes palpable above the

symphysis pubis on the 12th week of

pregnancy
 The average height of the fundus is 35 cm.

if this is divided by 3.5 cm, the age of the

pregnancy in lunar months is obtained
 EDC is determined in relation to landmarks

on the abdomen namely: symphysis pubis,

umbilicus, and the xiphoid process
 If the fundus is located above the
symphysis pubis, measure the distance
between the upper border of the symphysis
pubis and the top of the fundus.
 Fundal height in centimeters roughly equals

gestational age in weeks.

 This is particularly true between 16 and 36

weeks.
 Example:
 At 20 weeks of gestation, the fundal height

should measure approximately 20cm

 At 28 weeks, it should measure

approximately 28 cm
 If fundal height exceeds weeks of gestation,
additional assessment is necessary to
investigate the cause of the unexpected
uterine size.
 It may be that EDD is incorrect and the

pregnancy is farther advanced than

previously thought
 It may be the EDD is correct, but more than

one fetus is present

 Or the cause may be excessive fluid or
hydatidiform mole (which must be
investigated).
 If fundal height is less than expected on the

basis of gestational age, confirm the EDD.

 If dates are accurate, further assessment

may be necessary to determine whether the

fetus is experiencing intrauterine growth
retardation (IUGR)
McDonal’s Rule
Compute the EDC by adding the number
of remaining weeks/months from 40 weeks
or 10 lunar months
Fundal height in weeks
35.0 – 36 weeks. (just below the xiphoid)
24.5 – 30 wks. (2 fingers below the xiphoid)
21.0 – 28 wks. (midway between the
umbilicus)
19.0 – 24 wks. (2 fingers above the
umbilicus)
18.5 – 20 wks. (level of umbilicus)
14.0 – 16 wks. (2 fingers below the umbilicus)
10.5 – 12 wks. (midway)
7.0 – 8 wks. (just above symphysis pubis)
 Steps Example

Date of examination July 15, 2001

Height of fundus 2 fingers below the umbilicus

(14 cm)

Age of pregnancy
40 wks – 16 wks
24 wks. Remaining (6
months)
EDC is January 2002
Computation of AOG (Age of
Gestation)
 A. By means of LMP
 LMP – March 26, 2016
 Date of Consultation (present) = June 20,

2016
 Mar. = 5 days
 Apr. = 30 days
 May = 31 days
 June = 20 days

= 86 days/7 = 12 weeks and 2 days

 By means of Fundic Height
 Fundic height in cm divide by 4 = AOG
 Example:
 24 cm (fundic height)

4
= 6 months or 24 weeks
Height and weight
measurement
 An initial weight is needed to establish a
baseline for weight gain through out
pregnancy.
 Compare weight to the ideal-weight-for-

height charts to determine whether the

expectant mother is underweight or
overweight and to identify nutritional needs.
 Preconception weight below 45 kg (100
pounds) or height under 150 cm are
associated with preterm labor and low birth
weight infants.
 Preconception weight above 90 kg (200

pounds) is associated with increased

incidence of pregnancy-induced glucose
intolerance (Gestational diabetes) and
pregnancy-induced hypertension (pre-
eclampsia)
 Weight
 Weight is usually measured when a client is

admitted to a health agency

 Each morning before breakfast
 Scales measure in pounds (lb) or kilogram

(kg)
 One Kilogram is equal to 2.2 pounds.
 When accuracy of measuring weight is
essential, use:
= the same scale each time,
= take the measurements at the same
time each day, and
= make sure client has on a similar kind
of clothing and no footwear
 To ensure you take reliable measurements
using body weight scales you must:
 Zero the scales before the client steps onto

them
 Ask the client to remove any ‘heavy’ items

from their pockets (key’s, wallets etc.) and

remove any heavy items of clothing or
apparel (big jackets, shoes, woolen jerseys
etc.)
 Ensure you note the clients state and time
of day for testing to ensure any subsequent
tests can be taken under identical
conditions (check state of hydration, food
consumed recently etc.)
 When measuring weight – ask client to look

straight ahead and stay still on the scales.

Wait for the needle/digital screen to settle
before recording the measurement
 Ask your client to stand with their back to
the wall and look directly forward.
 The back of their feet, calves, bottom,

upper back and the back of their head

should all be in contact with the wall.
 They should be positioned directly

underneath the drop-down measuring

device.
Weight measurement
 Height
 When taking measurements of height, you

must:
 Ask your client to remove their shoes prior

to taking the measurement

 Ask your client to stand with their back to

the wall and look directly forward.

Height measurement
 The back of their feet, calves, bottom,
upper back and the back of their head
should all be in contact with the wall.
 They should be positioned directly

underneath the drop-down measuring

device.
 Lower the measuring device until it rests

gently on the top of your client's head and

record the measurement
Fetal Heart Tone
 Fetal heart sounds can be heard with a
fetoscope by 18 to 20 weeks of gestation
 The electronic Doppler scan amplifies fetal

heart sounds so that they are audible by 10

to 12 weeks
 It is necessary not only to hear the fetal

heartbeat but also to distinguish it from the

maternal pulse
Fetal heart tone by
doppler
FHT via Stethoscope
FHT by Fetoscope
 The FHR is generally between 110 and 160
BPM and should be auscultated while the
brachial pulse of the expectant mother is
being assessed.
 The FHR is muffled by amniotic fluid, and

the sound has been likened to that of a

clock ticking behind a pillow
 The location changes because the fetus

moves freely in the amniotic fluid.

 The site of FHR provides information that
may help determine in what position the
fetus is entering the pelvis.
 Example: FHT heard in the upper quadrant

of the abdomen suggest that the fetus is in

breech presentation
Danger signs of pregnancy
 Vaginal bleeding with or without discomfort
 Rupture of membranes (escape of fluid from

the vagina)
 Swelling of the fingers (rings becomes tight)

or puffiness of the face around the eyes

 Continuous pounding headache
 Visual disturbances (blurred vision,

dimness, spots before the eyes)

 Persistent or severe abdominal pain
 Chills or fever
 Painful urination
 Persistent vomiting
 Change in frequency or strength of fetal

movements
Thank you for listening…

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