Assessing Childbearing Women

• 3 Kinds of Pregnancy Signs

  • Presumptive Signs
  • Probable Signs
  • Positive Signs
• Presumptive Signs


  • Amenorrhea
  • Nausea and Vomiting
  • Frequent Urination
  • Breast Tenderness
  • Quickening
  • Skin Changes
  • Fatigue
• Probable Signs


  • Abdominal Enlargement
  • Hegar's Sign
  • Goodell's Sign
  • Chadwick's Sign
  • Braxton Hicks Contractions
  • Pregnancy Test
  • Ballottement
• Positive Signs


  • Fetal Heartbeat
  • Visualization of the Fetus (Ultrasound)
• Expected Date of Confinement (EDC)

  Computation of the expected date of confinement
• Normal Blood Pressure


  • Systolic: 90-139 mmHg
  • Diastolic: 60-89 mmHg
  • Decreased BP: 2nd Trimester
  • Back to Normal: 32-34 Weeks
• Abnormal Blood Pressure


  • Elevated BP at 9-11 weeks
  • Increased BP after 20 weeks
  • Decreased BP
• Normal Pulse Rate


  • 60-90/100 beats per minute (bmp)
  • May increase 10-15bpm
• Abnormal Pulse Rate


  • Irregularities in heart rhythm
  • Chest Pain
  • Dyspnea
  • Edema
• Normal Temperature


  • 97-98.6 Fahrenheit (F)
  • 36.5-37.5 Celsius (C)
• Abnormal Temperature


  • Elevated temperature above 100F
• Normal Weight Gain


  • 1st trimester – 2-4lbs
  • 2nd&3rd – 11-12lbs
  • Total weight gain: 23-35lbs
• Abnormal Weight Gain


  • Exceeding 5lbs/week
  • Less than 2lbs/month
• Normal Behavior


  • 1st Trimester – Tired, Ambivalent
  • 2nd Trimester – Introspective, Energetic
  • 3rd Trimester – Restless, Preparing for Baby, Labile Moods
• Abnormal Behavior


  • Denial of pregnancy
  • Withdrawal
  • Depression
  • Psychosis
• Normal Skin, Hair, and Nails

  • Linea Nigra
  • Striae Gravidarum (stretch marks)
  • Cholasma
  • Palmar Erythema (pinkish/red palms)
  • Increase Growth, Softening and Thinning of Hair and Nails
• Abnormal Skin, Hair, and Nails

  • Pale Skin – anemia
  • Yellow discoloration of skin – jaundice
• Your patient is anemic if hemoglobin drops below 10g/dl
• Normal Ears


  • Decreased hearing
  • A sense of fullness in the ears or earaches
• Normal Mouth, Throat, and Nose


  • Gum hypertrophy and bleeding gums while brushing teeth is common
  • Epulis (red raised nodule)
• Normal Thorax and Lungs

  • Increased anteroposterior diameter
  • Thoracic breathing
  • Slight hyperventilation
  • Shortness of breath in late pregnancy
  • Lung sounds are clear
• Normal Breasts


  • Increased and nodular
  • Colostrum is excreted
  • Hyperpigmentation of nipples and areola is evident
• Abnormal Breasts


  • Nipple inversion
  • Localized redness, pain, and warmth
  • Bloody discharge of the nipple and retraction of the skin
• Watch of signs of supine hypotension tension syndrome: Pallor, Dizziness, Faintness, Breathlessness, Tachycardia, Nausea, Clammy skin
• Normal Peripheral Vascular


  • Dependent edema (3rd trimester)
  • Varicose Veins
• Abnormal Peripheral Vascular


  • Calf pain
  • Positive Homan's sign
  • Generalized edema
  • Diminished pulses
• Normal Abdomen


  • Palpable uterus beginning at 10 to 12 weeks gestation
  • Fetal movement (approximately 18-20 weeks)
  • Uterus contracts and feels firm [mild, moderate, or firm to palpation – intensity of contractions]
  • Contractions may last 40-60 seconds and occurs every 5-6 minutes
  • Uterine size should approximately equal the number of weeks of gestation
  • Fetal heart rate: 120-160bpm

  
• Leopold's Maneuver
• Normal External Genitalia


  • Enlarged labia and clitoris, parous relaxation of the introitus, and scars form an episiotomy or perineal lacerations
  • No discomforts or discharge with examination
• Normal Internal Genitalia


  • Cervix should look pink, smooth, and healthy
  • Chadwick's sign
  • Fish Mouth
  • Leukorrhea
  • Hegar's sign
  • The uterus should feel about the size of an orange (10 weeks) and about the size of a grapefruit (12 weeks)
  • No palpable masses
• Normal Musculoskeletal


  • Forward tilting of pelvis
  • Changes in posture and walking style