Care of the Mother and the Fetus during the Perinatal Period

• Prenatal Care

  • is essential for ensuring the overall health of newborns and their mothers
  • A strategy for helping mothers to reduce complications of pregnancy
• Health Assessment during the first Prenatal visit First Prenatal Visit

  • First visit – as soon as they suspect they are pregnant
  • Every 4 wks. through - 28th wk. of pregnancy
  • Every 2 wks. through - 36th wk. and then every wk. until birth
• Screening on the first Prenatal visit:

  • Health history
  • Complete physical examination (Pelvic examination)
  • Blood and urine specimen for laboratory analysis
  • Manual pelvic measurement to determine pelvic adequacy
• Components of Health history

  • Demographic Data
  • Chief concern
  • Family profile
  • History of Past Illnesses
  • History of Family Illnesses
  • Day History/ Social Profile
  • Gynecologic History
  • Past Surgery
  • Reproductive Planning
  • Sexual history
  • Stress Incontinence
  • Obstetric History
• Demographic Data – name, age, address, religion, place of employment, ethnicity
• Chief concern

  • Document the date of LMP
  • Signs of early pregnancy
  • Discomfort of pregnancy
  • Danger signs (bleeding, abdominal pain, continuous headache, visual disturbances
• Tetracycline – antibiotic causes long bone defects in fetus
• Herbal supplement -stimulate uterine contraction and interfere with fetal health
• Intimate Partner Violence – need to be identified the amount and severity of violenc
• Menstrual History – (Menarche, cycle, interval, duration, amount of menstrual flow, any discomfort)
• Menarche – first menstrual period
• Dysmenorrhea – painful menstruation
• Perineal self-examination – inspecting external genitalia monthly for signs of infections or lesions
• Breast self-examination – normal breast changes during pregnancy
• Mammograms when they reach 40years old, a yearly breast examination by health care provider
• Obstetric History – determining gravidity and Parity
• Parity or Para – the number of births after 20 weeks, whether live births or stillbirths
• Abortion is not included in parity count, because in abortion, the fetus is delivered before the age of viability (before 20 weeks)
• Live birth or stillbirth is counted in Parity count, whether the fetus is born alive or stillbirth
• Stillbirth - is the delivery after the 20th week of pregnancy, of a baby who has died
• Gravida- number of pregnancies regardless of duration or outcomes (Total Pregnancy)
• A gravida (G) is a woman who:

  • Is pregnant (present) now
  • Has been pregnant (past), irrespective of the outcome of pregnanc
• A nulligravida (G) is a woman who:

  • Is not pregnant now
  • Has never been pregnant
• Gravida - number of pregnancies regardless of duration or outcomes (Total Pregnancy)
• Primigravida – is a woman who is pregnant for the first time (G1)
• Multigravida – is a woman who has been pregnant previously (G2 and more)
• Grand multigravida – is a woman who has had six or more pregnancies (G6 and more)
• Primipara - is a woman who has given birth to one child past age of viability
• Multipara – is a woman who has carried two or more pregnancies to viability (before 24 weeks, weighs 500-600 grams)
• Grand multipara – is a woman who has had 6 or more viable deliveries, whether the fetuses were alive or dead
• Obstetrical Scoring – a comprehensive system for classifying pregnancy status
• Naegele’s Rule - is the standard method used to predict the length of pregnancy.
• Mc Donald’s Rule - helps in estimating fetal gestational age using fundic height.
• Bartholomew’s rule – measures AOG by determining the position of the uterus in the abdominal cavity
• 12 weeks – the uterus becomes palpable as a firm globular sphere showing over the symphysis pubis
• 20th weeks – palpable at the level of the umbilicus (5 mos.)
• 36th weeks – touches the xiphoid process (9 mos.)
• 38th week – 2 weeks before term for primigravida the fetal head settles into the pelvis and the uterus returns to the height it was at 36 weeks
• Leopold’s Maneuver - are systematic abdominal palpation to determine the position and presentation of the fetus. They are done at about 32 weeks and over.
• Factors that affect reliability of findings:

  • Obesity
  • Polyhydramnios
  • Anterior placental location