MATERNAL CHILD NURSING

TERM DEFINITION

Para Number of pregnancies that have reached

viability, regardless of whether the infants
were born alive.

Gravida Woman who is or has been pregnant.

(number of times she has been pregnant,
including present pregnancy.

Primigravida Woman who is pregnant for the first time.

Primipara Woman who has given birth to one child past

age of viability.
(number of children above the age of viability
she has previously borne)

Multigravida Woman who has been pregnant previously.

Multipara Woman who has carried two or more

pregnancies to viability.

Nulligravida Woman who has never been and is not

currently pregnant.

● For 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. A woman who has had two
miscarriages at 12 weeks (under the age of viability) and is again pregnant is a gravida 3,
para 0.
Stages of Pregnancy
1. Antepartal/Antepartum/Prenatal Period - time between conception and labor; period of
pregnancy until onset of labor.
2. Intrapartum/Intrapartal Period - begins with the first true contractions and ends with the
complete dilatation of the cervix.
3. Postpartum/Postpartal/Puerperium Period - the interval between the birth of the newborn
and the return of the reproductive organs to their normal non-pregnant state.

>Duration of Pregnancy averages 280 days or 40 weeks (10th lunar months; 9 calendar months)
from the 1st day of the last normal menstrual period.
>Duration may also be divided into 3 equal parts, or trimesters, of slightly more than 13 weeks
or 3 calendar months each.

OBSTETRICS HISTORY

TERM DEFINITION

Para Number of pregnancies that have reached

viability, regardless of whether the infants
were born alive.

Gravida Woman who is or has been pregnant.

(number of times she has been pregnant,
including present pregnancy.

Primigravida Woman who is pregnant for the first time.

Primipara Woman who has given birth to one child past

age of viability.
(number of children above the age of viability
she has previously borne)

Multigravida Woman who has been pregnant previously.

Multipara Woman who has carried two or more

pregnancies to viability.

Nulligravida Woman who has never been and is not

currently pregnant.

● For 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. A woman who has had two
 miscarriages at 12 weeks (under the age of viability) and is again pregnant is a gravida 3,
para 0.

TPAL
In some obstetric services, a woman’s obstetric history is summarized by a series of four digits,
such as 5-0-2-5. These digits corresponds with the abbreviation TPAL.
a. T - full term deliveries, 37 completed weeks or more. (infants born at 37 weeks or after
b. P - preterm deliveries, 20 to less than 37 completed weeks. (infants born before 37
weeks)
c. A - abortions, elective or spontaneous loss (misscariage) or a pregnancy before the period
of viability. (
d. L - the number of children living. If a child has died, further explanation is needed for
clarification.

GPTALM
In some situations, a woman’ obstetrics history can also be summarized as GTPALM.
1. G - gravid
2. T - full term deliveries, 37 completed weeks or more.
3. P - preterm deliveries, 20 to less than 37 completed weeks.
4. A - abortions, elective or spontaneous loss of pregnancy before the period of viability.
5. L - the number of children living. If a child has died, further explanation is needed for
clarification.
6. M - the number of multiple gestations and births (not the number of neonates delivered).

MANIFESTATIONS OF PREGNANCY
Categories of Signs and Symptoms of Pregnancy
PRESUMPTIVE PROBABLE POSITIVE

Physical S/S that suggest, but Objective findings detected Diagnostic of Pregnancy
do not prove, pregnancy by 12-16 weeks of gestation
1. Abrupt Cessation of 1. Enlargement of
MEnses - Pregnancy
is suspected if more
than 10 days have
elapsed since the time
of the expected onset
in a healthy woman
previously had
predictable menstrual
periods.
1. Fetal Heart tones
abdomen - at about 12 (FHT’s) - usually
weeks gestation, the heard between 16th
uterus can be felt and 20th week of
through the abdominal gestation with a
wall, just above the fetoscope of the 10th
symphysis pubis. and 12th week of
gestation with a
Doppler.

2. Breast changes: Breast 2. Changes in shape, size 2. Fetal movement felt

enlarge & become and consistency of the by the examiner
tender increasingly uterus - uterus after about 20
visible. enlarges, elongates week’s gestations.)
● Nipple become and decreases in
larger & more thickness as
pigmented. pregnancy progresses.
Nipple tingling The uterus changes
can may be from a pear shape to a
also be globe shape.
present. ❖ HEGAR’S SIGN -
● Colostrums, a Lower uterine
thin, milky segment softens 6-8
fluid, may be weeks after onset of
expressed in the last menstrual
the 2nd half of period.
pregnancy.
● Montgomery’s
glands, small
elevations on
the areola, may
appear.

3. Skin PIgmentation 3. Changes in the Cervix: 3. Outlining of the fetal

changes: CHADWICK’S SIGN - body through the
3.1. Bluish or purplish maternal abdomen in
CHLOASMA/MELA discoloration of the the 2nd half of
SMA cervix & vaginal wall. pregnancy.
GRAVIDARUM (the GOODELL's SIGN -
mask of pregnancy) - softening of the
brownish cervix, may occur as
pigmentation early as 4 weeks.
appearing on the face *With inflammation*
in a butterfly pattern Carcinoma during
in 50-70% of women. pregnancy, the cervix
 It is usually symmetric may remain firm.
and is distributed on
the forehead, cheeks,
& nose.
The mask of
pregnancy is more
common in dark-
haired, brown eyed
women & is
progressive
throughout the
pregnancy.
3.2 LINE NIGRA -
dark vertical line on
the abdomen between
the sternum &
symphysic pubis.
3.3 STRIAE
GRAVIDARUM/AB
DOMINAL STRIAE -
reddish or purple
linear marks
sometimes appearing
on the breasts,
abdomen, buttocks &
thighs because of the
stretching, rupture and
atrophy of the deep
connective tissue of
the skin.

4. NAUSEA AND 4. Intermittent 4. Sonographic evidence -

VOMITING (morning
sickness) - occurs
mainly in the morning
but may occur at any
time of the day,
lasting a few hours.
Begins between 2 & 6
weeks after
conception and
usually disappears
spontaneously near the
end of the 1st
trimester (12 weeks).
contractions of the (after 4 weeks
uterus (BRAXTON gestation) using
HICKS vaginal ultrasound.
CONTRACTIONS) - Fetal cardiac motion
Painless, palpable can be detected by 6
contractions occurring weeks gestation.
at irregular intervals,
more frequently felt
after 28 weeks. They
usually disappear with
walking or exercise.
 5. Frequency of 5. Ballotment - sinking &
Urination - caused by rebounding of the
pressure of expanding fetus in its
uterus on the bladder. surrounding amniotic
● Decrease when fluid in response to a
uterus rises out sudden tap on the
of the pelvis uterus. (occurs near
(around 12 mid-pregnancy).
weeks).
● Reappears
when the fetal
head engages
in the pelvis at
the end of
pregnancy.

6. Fatigue - characteristic 6. Changes in levels of

of early pregnancy in HCG of human
response to increased chorionic
hormonal levels. gonadotropin in
maternal plasma &
urine.

7. Increase in vaginal
discharge.
8. QUICKENING
(Sensation of fetal
movement in the
abdomen) - occurs
between the 16th &
2oth week after the
onset of the last
menses.
9. Positive HCG -
laboratory (uterine or
serum) test for
pregnancy.

Maternal Computations:
1. NAGELE’S RULE - the most common method of determining the expected date of
delivery (EDD). This is just an estimate & is said that 40% of all babies arrive “on time”
when using this rule, whereas, 60% appear 1 to 7 days early or late.
2. McDONAL’S RULE - this methods determines the height of the fundus during
pregnancy. In later pregnancy as in the 3rd trimester, variations in fetal weight decrease
the accuracy of fundic height measurements. Fundic height (FH) in cm correlates well
with weeks of gestation between 20-31 weeks. The limitation of this method is that is
yields inaccurate result in women with obesity. Polyhydramnios & uterine fibroids.
○ Equipment: a centimeter measuring tape