Don Mariano Marcos Memorial State University

South La Union Campus

COLLEGE OF COMMUNITY HEALTH AND ALLIED MEDICAL SCIENCES
Agoo, La Union

Determining Gravidity and Parity

I. Gravida:
Refers to a pregnant woman
Total numbers of pregnancies regardless of duration and outcomes (including the present
pregnancy)

A gravida (G) is a woman who:

 Is pregnant (present) now
 Has been pregnant (past), irrespective of the outcome of the pregnancy

 Nulligravida - woman who has never been pregnant

 Primigravida - woman pregnant for the first time
 Multigravida - woman who has had 2 or more pregnancies
 Grand multigravida- 6 or more pregnancies

II. Para/Parity:
The total numbers of pregnancies that reached age of viability (after 20 wks and beyond, birth wt
of more than 500 grams and beyond) and subsequently delivered whether live births or stillbirths.

 Nullipara- woman who has never delivered a fetus that reached the age of viability
 Primipara- woman who has completed one pregnancy to viability
 Multipara- woman who has completed 2 or more pregnancies to viability
 Grand multipara- woman who has had 6 or more viable deliveries

III. Principles in Identifying Parity

A. The number of pregnancies is counted and not the number of foetuses. Multiple pregnancies do
not increase parity.
e.g.,
Aryana is pregnant for the first time and is carrying twins. She is presently G1P0. At 37 to 38
wks, she delivered to a monozygotic twin making her G1P1.

B. Abortion is not included in parity count because in abortion, the fetus is delivered before the
age of viability (before 20 weeks)
e.g.,
Micai is pregnant for the 2nd time. Her first pregnancy 3 yrs ago ended in an abortion. Micai is
presently G2P0. After delivery of a preterm or fullterm baby, she will be designated G2p1. What
if, Micai’s pregnancy ends in abortion at 12 wks?

C. Live birth or stillbirth is counted in parity count.- as long as it reached 20 wks.

e.g.,
Emily is pregnant for the first time (G1P0). After 34 weeks, she delivered a 4- lb. Baby boy with
no signs of life (stillbirth). This makes Emily a primipara (G1P1)

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 Estimates in Pregnancy
I. EDC (expected date of confinement)/ EDD (expected date of delivery)

A. Naegele’s Rule
-Most commonly used method
-the average human pregnancy was 266 days from conception, or 280 days (40
weeks) from the first day of the of the last menstrual period

Procedure:

a. Determine the last menstrual period (LMP)

b. Consider the first day of LMP
c. Consider the month in numeric terms
e.g.,
January: 1 July: 7
February: 2 December: 12
May: 5 and so forth

For the first three months of the year, add 12 to the numerical value.
e.g.,
January : 1 + 12= 13
February : 2 + 12 = 14
March : 3 + 12 = 15
d. Use Naegele’s formula
Sample Problem 1:
The given LMP is March 5-10, 2012. The numerical value of March is 3, thus...

15 5
- 3
12 5
+ 7
12 12 = EDD: December 12, 2012-06-16
Sample Problem 2:
The given LMP is June 12-17, 2012. The numerical value of June is 6, thus...
6 12 2012
-3 + 7 + 1
3 19 2013
* Subtract 3 calendar months, add 7 days to the first day of menstrual period then add 1 year.

B. Mittendorf’s Rule

- alternative to Naegele’s Rule in determining EDC/EDD

-showed that an average pregnancy is 269 days for mothers who’ve given birth before. Non-
Caucasian women have shorter pregnancies than Caucasian; for example, African-American
women average 266 days

Procedure:
1. Determine the first day of the last menstrual period (LMP.)
2. Categorize the woman as Caucasian or non-Caucasian race.
3. Identify her gravidity: primigravida (G1) or multigravida (G2 or above)

Formula: For primigravid Caucasian women

LMP + 15 days (constant) – 3 months = EDD

e.g.,
What is the EDD of Mrs. Park, a first time pregnant Caucasian with LMP of May 14?
Solution:
Month Day

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 5 14
- 3 + 15

2 29 = EDD: February 29

Formula: For multigravid non-Caucasian women

LMP + 10 days (constant) – 3 months = EDD

e.g.,
What is the EDD of Mrs. Dela Cruz, G2 Filipino woman with LMP of August 10?
Solution:
Month Day

8 10
- 3 + 10

5 20 = EDD: May 20

*The Nagele rule is based on 280 day-from-LMP gestational age while Mittendorf believe multiparas
and non-white women deliver 5 days in advance.

C. EDD based on quickening

Primigravida: Date of Q + 4 months and 20 days = EDC
Multigravida: Date of Q + 5 months and 4 days = EDC

II. AOG (Age of Gestation)

Date of pregnancy or gestational age can be established using certain clinical milestones.
 Early prenatal care
 Quickening
 Auscultation of fetal heart tones
 Fundic height
 Ultrasound
 X-ray

A. Early prenatal care

o simplest method of establishing gestational age
o if a woman seeks prenatal care within 2 weeks after missed menses and has a positive
pregnancy test , this is indicative of a pregnancy of six weeks duration, that is counting
from the first day of last menstrual period.

B. Quickening
o -first sensation/perception of fetal movement by the mother
o -felt as a slight fluttering movement in the abdomen
o occurs between 18 and 20 weeks
o -related to parity and placental location

 Placenta on anterior uterine wall

19 wks in primigravidas
17.5 wks in multiparas
 Placenta on posterior uterine wall
18 wks in primigravidas
16.1 wks in multiparas

C. Auscultation of fetal heart tones

12 wks- Doppler ultrasound
17 to 19 wks gestation- Delee fetoscope
20 wks- ordinary unamplified stethoscope
D. Fundic Height
-measured using a tape measure
- assessment :
 12 weeks: level of symphisis pubis
 16 weeks: halfway bet. Umbilicus and symphisis pubis
 20 weeks: level of umbilicus
 24 weeks: 2 fingers above umbilicus
 28-30 weeks: halfway bet umbilicus and xyphoid process

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  32-34 weeks: just below the xyphoid process
 36 weeks: level of xyphoid process
 40 weeks: at 34 weeks level due to lightening

The DOH prescribed in its HBMR the ff. fundic heights level in the second half of
pregnancy.

 Fifth month gestation: 20 cm

 Sixth month gestation: 21-24 cm
 Seventh month gestation: 25-28 cm
 Eight month gestation: 29-30 cm
 Ninth month gestation: 30-34 cm
Fundic height in centimetres correlates to gestational age between 20-31 weeks. This
commonly accepted measurement is McDonald’s Rule
*Instruct the mother to void before fundic height detection.

D.1 McDonald”s Rule method

- used to determine the age of gestation by measuring from the fundus (obtaining the fundal
height) to the symphysis pubis.

 Estimating Fundic Height: McDonald’s Method

-indicator of uterine size in early pregnancy

Equipment:
A centimetre tape measure

Procedure:

1. Explain the procedure to the mother

2. Ask the mother to empty her bladder. A full bladder displaces the uterus, causing an
inaccurate measurement.
3. Position the mother on dorsal recumbent.
4. Drape.
5. Measure the distance abdominally from the top of the symphisis pubis over the curve of
the abdomen to the top of the uterine fundus.

Limitation:
Inaccurate in women with conditions such as obesity, polyhydramniosand uterine fibroids.
These results to bigger-than-date fundus.

 Estimating Gestational Age: McDonald’s Rule

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 Procedure:
1. Explain the procedure to the client.
2. Instruct the woman to void.
3. Measure the fundic height using McDonald’s Rule (from the symphisis pubis to the top
of the fundus).

Formula:
a. Computing in lunar months, multiply the fundic height by two then divide by seven.

FH (in cm) x 2
= Gestational age in lunar months
7
Problem 1: What is the estimated gestational age in months if the fundic height is 31.5cm?
Solution:
31.5 x 2 64
= = 9 months
7 7
Problem 2 : What is the estimated gestational age in months if the fundic height is 21 cm?
Solution:

21 x 2 42
= = 6 months
7 7

b. Computing in weeks, multiply the fundic height by eight then divide by seven

FH (in cm) x 8
= Gestational age in weeks
7
Problem 3: What is the estimated gestational age in weeks if the fundic height is 36 cm?
Solution:
36 x 8 288
= = 41- 42 weeks
7 7
Problem 4: What is the estimated age in weeks if the fundic height is 21 cm?
Solution:
21 x 8 168
= = 24 weeks
7 7

D.2 Bartholomew’s Rule of fourths

- estimates the age of gestation relative to the height of the fundus of the uterus above the
symphysis pubis.

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  By 3rd lunar month (12 weeks), the fundus is slightly palpated above the
symphysis pubis.
 By the 5th lunar month (20 weeks), the fundus is palpable at the level of the
umbilicus.
 On the 9th lunar month, the fundus is at the level of the xiphoid process.

E. Ultrasound
-most accurate way for confirming gestational age
-measures biparietal diameter (measurement bet the 2 parietal eminences of the fetal skull)
which is useful during the 2nd trimester and becomes less accurate as pregnancy
advances
 Biparietal diameter of 9.5 cm = mature fetus; attained at 36 weeks gestation

F. X-ray
-after 15 weeks to be safe
 Identification of distal femoral ossification = 36 weeks
 Identification of proximotibial ossification = mature

Proverbs19: 20

Listen to advice and accept

instruction, and in the end
you will be wise.

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