ASSESSMENT OF THE CHILDBEARING WOMAN
hypertension, Diabetes mellitus,
 Pregnancy is divided into trimesters
 Pre-natal check-up frequency:
- First 27 weeks of pregnancy- every month
- 28th-36th week of pregnancy- every 2
weeks
- 37th week onwards- every week
Collection of Data
A. Subjective data
A1. Health History
B. Objective Data
B1. Physical examination
B2. Pelvic exam
B3. Ultrasound (UTZ)
B4. Laboratory exam (blood and urine
exams)
HEALTH HISTORY PURPOSES
1. Establish rapport
2. Gain information about the woman’s physical
and psychosocial health
3. Obtain a basis for anticipatory guidance for the
pregnancy
COMPONENTS OF HEALTH HISTORY
1. Demographic Data
 Name, Age (16-35), Address, phone
number, religion, health insurance info,
educational attainment
2. Chief Concern
- Check the Last Menstrual Period (LMP)-
first day of the last menstruation
- Ask information about early signs of
pregnancy - nausea & vomiting, breast
changes or fatigue
- Ask information about discomfort of
pregnancy - constipation, backache or
frequent urination
 Has she been exposed to any contagious
disease?
 Has she taken any medications?
 Did she experience any danger of pregnancy
e.g. bleeding, continuous headache, visual
disturbances or edema?
 Is this pregnancy planned or not?
3. Family Profile
- Identify support persons
- Educational level and occupation
4. History of Past illnesses
- Kidney disease, heart disorder,
thyroid disease, seizures, gallbladder
disease, Urinary Tract Infection (UTI),
varicosities, Phenyketonuria (PKU),
tuberculosis (TB), asthma 
- STD (Hepa B, HIV), chickenpox, mumps,
measles (Rubeola), German measles
(Rubella), polio
5. History of Family illnesses
- Cardiac problems, renal problems, DM,
cognitive impairment, blood disorders or
any known inherited or congenital
anomalies
6. Day history & Social Profile
- Current nutrition, elimination, sleep,
recreation and interpersonal interactions
- Ask the client to describe a typical day
- Ask about cigarette and alcohol use
- Ask about use of Isotretinoin (Vit A
preparation)
7. Gynecologic History
Menarche - age of the very first
menstruation
- Cycle of menstruation, interval, duration,
amount of menstrual flow &
discomforts commonly experienced
- Past surgeries and procedures – tubal
surgery, Cesarean Section (CS), Dilation
& Curettage (D&C) etc
- Reproductive planning method used
Stress Incontinence – involuntary passage
of urine while coughing, jogging or
running
Cause: lack of strength of perineal muscles
and bladder support
8. Obstetric History
- Ask about previous pregnancies
 Para - The number of pregnancies that
reached viability (24 weeks, reached 400 g),
regardless of whether the infants were born
alive or not 
 Gravida - a woman who is or has been
pregnant
 Gravida - the number of times the woman has
been pregnant
 Para - the number of pregnancies carried past
the age of viability (24 weeks AOG)
 Primigravida - a woman who is pregnant for other year her 2 year old baby died due to an
the first time accident
 Primipara - a woman who has given birth to G5 P4
one child past age of viability G-5 T-4 P-0 A-0 L-3 M-0
 Multigravida - a woman who has been G5 40030
pregnant previously
Weight:
 Multipara - a woman who has carried two or
Pre-pregnancy Weight Allowable weight gain
more pregnancies to viability
Status during the entire
 Nulligravida - a woman who has never been
pregnancy
and is not currently pregnant
Normal Weight 23 – 35 lbs
Overweight 15 – 25 lbs
ꬹ G- Gravida- the number of times the woman
Obese 15 lbs
has been pregnant including the current
pregnancy
ꬹ T- Full term – children born at 37 weeks or Expected weight gain during pregnancy
after 1st trimester- 2-4 lbs
ꬹ P- Pre term- children born before 37 weeks 2nd trimester- 11 lbs
ꬹ A - spontaneous or induced termination of 3rd trimester- 11 lbs
pregnancy before the “age of viability” ASSESSMENT OF FETAL GROWTH &
Age of viability - refers to the age at which a DEVELOPMENT
fetus could survive outside the uterus if they A. Naegle’s rule
were born, usually at 24 weeks AOG or when - used to assess the Estimated Date of
the fetus weighs 400 gm or more Confinement (EDC)/ Expected Date of
ꬹ L - number of Living children Delivery
ꬹ M- number of multiple pregnancies - Based on the LMP, count back 3 mos then
Examples: add 7 days and 1 year
Note: You do not add one year if the LMP is from
A woman is currently pregnant 20 weeks Jan-Mar
AOG and has given birth last 2015 to a healthy
baby boy @ 37 weeks AOG and last 2018 to a A1.) LMP is Jan 20, 2020- count back 3 months =
healthy baby girl at 38 weeks AOG October 20+ 7days = October 27, 2020
G3 P2 EDC is October 27, 2020
G-3 T-2 P-0 A-0 L-2 M-0
G3 20020
A 25 year old is currently pregnant, she
gave birth 3 times (all 3 @ 37 weeks AOG), last
2019 her pregnancy got terminated @ 19 weeks
AOG
G5 P3
G5 T- 3 P-0 A-1 L-3 M-0
G5 30130

Ana is currently pregnant at 20 weeks A2.) LMP is March 3,2020- count back 3 months
AOG, she gave birth to twins at 37 weeks AOG, = December 3 + 7 days = Dec10,2020
last 2017 she also gave birth to a baby girl @ 34 EDC is Dec 10, 2020
weeks AOG
G3 P2
G-3 T-1 P-1 A-0 L-3 M-1
G3 11031

Maria is currently pregnant, she had 4

previous pregnancies, all delivered full term. The
A3.) LMP June 5, 2020- count back 3 months= Jun- 30
March July- 6
5+7 days= March 12, 2021 168/ 7 (constant)= 24 weeks AOG
EDC is March 12, 2021 

B2.) LMP Sept 25, 2019 Date of visit: May 31, 2020
Sept 30-25 =5
Sept - 5
Oct -31
Nov-30
A4.) LMP Is June 29, 2020- count back 3 months= Dec- 31
March 29 + 7 days = March 36, 2021 Jan- 31
Since there is no such date as March 36 we will Feb- 29 (since 2020 is a Leap Year)
subtract 31 which is the total number of days for Mar-31
the month of March and add 1 month. Apr- 30
EDC is April 5, 2021 May-31
249/7 = 35.6 or 36 weeks AOG

B3.) LMP June 8, 2020 Date of visit July 10, 2020

June 30-8 =22
June- 22
July - 10
32/7 = 4.6 or 5 weeks

A5.) LMP is October 31, 2019- count back 3
months= July 31+ 7 days= July 38, 2020
Since there is no such date as July 38 we
will subtract 31 which is the total number of
days for the month of July and add 1 month.
EDC is August 7, 2020
You are a nurse assigned to the RHU. A 26 year old
G2P1 came to the clinic for her scheduled pre natal
check up July 5, 2020. LMP is Feb 20,2020. Compute
for the EDC and AOG.
C. Mietendorf’s Rule
Primi: LMP + 15 days – 3 mos
Multi: LMP + 10 days – 3 mos

B. Computation for Age of Gestation (AOG)
Age of Gestation - used to describe how far along
pregnancy is. It is measured in weeks, from the
first day the woman’s LMP to the current date. A
normal pregnancy can range from 37-42 weeks.
B1.) LMP Jan 20, 2020 Date of visit: July 6, 2020
31 days for the month of Jan
31-20 (LMP)= 11
Jan- 11
Feb- 29 (since 2020 is a Leap year)
Mar-31
Apr- 30
May-31
D. If LMP is unknown
Quickening starts for Primi – 5 mos; Multi-
4 mos
 Primi: Date of the quickening + 4 mos + 20
days = EDC
 Multi: Date of the quickening + 5 mos + 4 days
= EDC
E. Estimating Fetal length in cm
Haase’s Rule= 1-5 mos square the month; 6-10
mos multiplied by 5
 Ex. at 3 months the fetus is expected to be 9
cm in length
 At 7 months the fetus is expected to be 35 cm
length
F. Mcdonald’s Rule - by measuring the fundal
height we can estimate the Age of Gestation
(AOG)
- the height in “cm” is equivalent to the AOG
- this is applicable during the 20th-31st week AOG - there may be slight enlargement of the
thyroid due to an overall increase in
 Bartholomew’s Rule - the AOG is estimated by metabolic rate
using the height of the fundus of the uterus in G. Lymph Nodes
correspondence with specific anatomical - there must be no palpable lymph nodes
parts H. Breasts
- increase in size due to hyperplasia of the
GENERAL APPEARANCE
mammary alveoli
A. Head
- Breast areola darkens and widens from 3.5
Chloasma (extra pigment on the face)
cm (pre-pregnancy) to 5-7.5 cm during
- Increased hair growth because of the
pregnancy
overall increased metabolic rate -
- A secondary areola may develop
increased melanin production
surrounding the natural one
- It became firmer in tone
- Blue streaks of veins may become
prominent
- Colostrum may be expelled as early as the
16th week of pregnancy yellowish
in color rich in antibodies good for the
B. Eyes baby
- edema on the eyelids, spots before the
eyes, diplopia (double vision): this is
indicative of Pregnancy Induced
Hypertension (PIH)
- Optic discs may be swollen in PIH
C. Nose
- Increased nasal stuffiness/nasal
PHYSIOLOGIC AND PSYCHOLOGICAL CHANGES
congestion or appearance of swollen nasal
DURING PREGNANCY
membranes due to increased level of
1. Presumptive Signs
estrogen
- those that are least indicative of
D. Sinuses
pregnancy, taken as single entities, they
- normally tender
could easily indicate other conditions;
E. Ears
largely subjective
- dampening of sound & feeling of fullness
because of increased stuffiness which
blocks the Eustachian tube; Increased
estrogen level
F. Mouth, Teeth & Throat
- pregnant women are prone to Vit.
Deficiency 2. Probable Signs
- Cracked corners of the mouth may a. Serum Laboratory Test
indicate Vit. A deficiency hCG - a hormone created by the chorionic
- Pregnant women are prone to tooth villi in the placenta.
decay because of increased reactivity of - Reaches a measurable level (50mIU/ml)
the tooth enamel to bacteria and due to a 7-9 days after conception
decrease of pH in the mouth - Peaks at about 100mIU/ml but by the
Gingival Hypertrophy - due to increased 60th- 80th day after this it declines again
estrogen stimulation and is no longer detectable in the serum.
- Pinpoint lesions with an erythematous
base may indicate herpes infection
G. Neck
 b. Chadwick’s Sign - color change of the
vagina from pink to violet, increased blood
flow vascularization to the area
c. Goodell’s sign - softening of the cervix
d. Hegar’s sign - softening of the lower
uterine segment
e. Sonographic evidence of gestational sac
f. Ballottement- when lower uterine segment is
tapped on a bimanual examination, the fetus can
be felt to rise against the abdominal wall
g. Braxton Hicks contractions- periodic uterine
tightening – false contraction/practice
h. Fetal outline felt by the examiner
3. Positive Signs
a. Sonographic evidence of the fetal outline
b. Fetal heart tone is audible
- 18-20 weeks of pregnancy audible by an
ordinary stethoscope 120-160 bpm (fetal back –
listen heartbeat han baby)
c. Fetal movement felt by the examiner- 20th-
24th weeks AOG
PHYSIOLOGIC CHANGES OF PREGNANCY
A. REPRODUCTIVE SYSTEM
A1. Uterine Changes - increase in length, depth,
width weight, wall thickness and volume
 12th week - uterus is firm and sphenoid under
the abdominal wall just above the symphysis
pubis
Bartholomew’s Rule
 20th-22nd week- fundus is at the level of the
umbilicus
 36th week- fundus is at the level of the
xiphoid process
 38th-40th week- lowers
 Increase of blood flow to the uterus- pre-
pregnancy- 15-20 ml/min
 by the end of pregnancy- 500-750 ml/min 75 %
of which is going to the placenta
 Uterus is more anteflexed, larger, softer to
touch than usual
 6th week of pregnancy- lower uterine
segment just above the cervix becomes soft
(Hegar’s Sign)
 12th week of pregnancy- Braxton Hicks
contractions begin
 16th-20th week of pregnancy- Ballottement
may be noted
 20th-24th week- fetal outline may be palpated
A2. Amenorrhea - due to suppression to FSH
Other possible reasons: uterine infection,
climate change, worry, chronic illness such as
severe anemia or stress
A3. Cervical Changes - becomes vascular and
edematous
- becomes soft in consistency (Goodell’s
Sign) due to the high estrogen level
 Operculum - mucus plug which acts to seal
out bacteria during pregnancy and to help
prevent infection in the fetus and
membranes.
A4. Vaginal Changes
Estrogen - causes the vaginal epithelium
and underlying tissue becomes hypertrophic and
enriched with glycogen.
 Changes in color from pink to dark violet
(Chadwick’s Sign)
Chadwick’s Sign
Goodell’s Sign & Hegar’s Sign
 SYSTEMIC CHANGES
A. Integumentary System
A1. Striae gravidarum- pink or reddish streaks
appearing on the sides of the abdominal
wall and sometimes on the thighs. 

A2. Diastasis- separation of rectus muscle, bluish

groove at the site of the separation. At the 28th
week AOG the depression of the umbilicus
becomes obliterated and smooth.
A3. Linea nigra- dark line running from the
Pathologic Retraction Ring/ Bandl’s Ring
umbilicus to the symphysis pubis 

A4. Melasma/ chloasma or the mask of

pregnancy 

A5. Vascular spiders- small, fiery-red branching

spots commonly found on the thighs.

Actual picture of Bandl’s Ring

A6. Increased perspiration

 pH of vaginal secretions decreases from 7 to A7. Palmar erythema- due to increased estrogen
4-5 due to the action of Lactobacillus level in the body
acidophilus and Doderlein bacillus

A5. Ovarian Changes

B. BREAST CHANGES
 Estrogen - causes a feeling of fullness, tingling
sensation and tenderness
 Hyperplasia of the mammary alveoli
 Areola darkens and its diameter increases
from about 3.5 cm to 5 or 7.5 cm (1.5-2-3
inches)
 There is formation of secondary areola,
increase in vascularity, blue veins become
prominent over the surface of the breast,
sebaceous glands of the areola (Montgomery B. Respiratory System
tubercles) enlarge.  NO change in vital capacity
 16th week of pregnancy- colostrums is  Tidal volume is increased by 30-40 %
expelled from the nipples in a form of  Respiratory rate is increased by 1-2
thin watery fluid which is high in protein and cpm/minute (18-20cpm/min)
considered to be a precursor of breast milk  Residual volume- decreased by 20 %
  Plasma PCO2- decreased by 27-32 mHg
 PlasmaO2- increased to 104-108 mmHg
 Blood pH- increased to 7.40-7.45
 Respiratory minute volume- increased by
40%
 Expiratory reserve- decreased by 20%
 Increased ventilation
C. Temperature- increased slightly because of the
influence of the progesterone but this returns to
its normal level during the 16th week of
pregnancy
D. Cardiovascular System
D1. Blood volume increases by at least 30% and
possibly as much as 50%
 Normal blood loss for NSVD- 300-400 ml
 Normal blood loss for CS- 800-1000 ml
 The increase in blood volume peaks at the
28th-32nd week
D2. Iron needs- 800 mg during pregnancy
 True anemia- either a hemoglobin
concentration of less than 11.5 g/100 ml or
a Hct of less than 30%
D3. Folic acid- helps in preventing neural tube
defects
D4. Heart- increase in cardiac output by 25-50% -
increased blood volume
 HR increases by 10 bpm
 Innocent heart murmurs may be heard r/t
altered heart position and decreased
blood viscosity.
 Palpitations are also common due to the
stimulation of SNS
D5. Regional blood flow- impaired to the lower
extremities – varicosities, hemorrhoids
D6. BP- does not normally rise
D7. Supine hypotension syndrome- light
headedness, faintness and palpitations
 Interventions: lie on the left side and rise
from bed
D8. Blood Constitution
 Increase in circulating fibrinogen (as much
as 50 %) due to increased level of estrogen
 Increase in clotting factors VII, VIII, IX, and
X and platelet count
 Increase in WBC
 Decrease in total protein which may be a
cause of ankle edema
 Increase in body lipid by 1/3 and
cholesterol by 90-100%
E. Gastrointestinal System
 Slow intestinal peristalsis and emptying of
the stomach
 Heartburn, constipation and flatulence is
common
 Nausea and vomiting is common due to
increase level of hCG and progesterone or
as a systemic reaction to the increased
level of estrogen and decreased level of
glucose
 Subclinical jaundice may be experienced
 Hypertrophy of the gumlines and possible
bleeding of the gingival tissue
 Decreased pH in the mouth
F. Urinary System
 Glomerular filtration rate- increased by 50
%
 Renal plasma flow- increased by 25-80 %
 BUN- decreased by 25%
 Plasma creatinine level- decreased by 25%
 Renal threshold for sugar- decreased to
allow spillage
 Bladder capacity- increased by 1000 ml
 Diameter of ureters- increased by 25%
 Frequency of urination- increased in the
1st trimester and the last two weeks of
pregnancy to 10-12 times/day
G. Skeletal System
 Calcium and Phosphorous needs are
increased
 There is softening of pelvic ligaments and
joints which causes the waddling gait
H. Endocrine System
 Placenta produces hCG, estrogen,
progesterone, hPL, relaxin and
prostaglandins
 Estrogen- causes breast changes and
palmar erythema
 Progesterone- maintains endometrium
inhibiting uterine contractions and aids in
the preparation of the breasts for
lactation.
 Relaxin - secreted primarily by the corpus
luteum & inhibits uterine contractions;
softens the cervix and the collagen in
joints
  hCG - secreted by the trophoblast in the
placenta
& stimulates estrogen and progesterone
synthesis until the placenta can take its
role
 hPL - also known as human chorionic
somatomammotropin hormone; serves as
the antagonist to insulin, freeing fatty
acids for energy
 Prostaglandin - affects smooth muscle
contractility to such an extent they may be
the trigger that initiates labor at term
 Pituitary gland Common Measurements
- halted FSH and LH release because  Diagonal Conjugate
of increased levels of estrogen and - distance between the anterior surface of
progesterone the sacral prominence and the anterior
- late in pregnancy it produces surface of the inferior margin of symphysis
oxytocin pubis
- produces “prolactin” which - considered to be the most useful
prepares the breasts for lactation measurement for the estimation of pelvic
 Thyroid and parathyroid glands size.
- glands enlarges and BMR increases - suggests the anteroposterior diameter of
by 20% the pelvic inlet
- -Protein based-iodine, butanol- - Measured while the client is in a lithotomy
extractable iodine, and thyroxine position
are all elevated as well. - >12.5 cm- adequate for childbirth (average
 Adrenal glands fetal head is 9 cm)
- increased function due to increased
level of corticosteroid and
aldosterone.
- aids in suppressing inflammatory
reaction, helps in regulating the
glucose metabolism in the woman
- Increase in aldosterone aids in
promoting sodium reabsorption and
maintain osmolality with the amount
of fluid retained  True Conjugate Or Conjugate Vera
 Pancreas - measurement between the anterior
- increased production of insulin in surface of the sacral prominence and of
response to increased amount of the posterior surface of the inferior
glucocorticoid produced by the margin of the symphysis pubis.
adrenal glands. However insulin are - cannot be measured directly, sobtract the
less effective during pregnancy usual depth of the symphysis pubis
because of the increase level of (assumed to be 1.2-2 cm) from the
estrogen, progesterone, and hPL diagonal conjugate measurement.
which are antagonists to insulin. - actual diameter of the pelvic inlet (10.5-11
- FBS- 80-85 mg/100ml cm)

TYPES OF PELVIS:  Ischial Tuberosity Diameter

- distance between the ischial tuberosity or
the transverse diameter of the outlet.
Made at the medial or lowermost aspect
of the ischial tubersities at the level of the
anus (11 cm)

FETAL HEART RATE (FHR) or (FHT)

Use a Doopler or a Fetoscope

 10-12th week AOG- untrasonic Doopler is
used
 15-20th week- fetoscope is used
 FHR- 120-160 bpm
 During sleep cycle- 110-120 bpm

Abnormal Findings
 If the FHR is less than 110 bpm or more
than 160 bpm
 If there is decrease in FHR with fetal
movement
* This may be indicative of Fetal Distress

Assessing Fetal Movement

 Quickening is experienced approximatley
at 18-20 weeks AOG and peaks at the 28 th-
38th week AOG
 Decreased Fetal movement may indicate
PLACENTAL INSUFFICIENCY or FETAL
DISTRESS
 A healthy fetus moves at least 10x a day
 Let the client assume a Left recumbent
position after a meal and record how
many movement she feels over the next
hour
 Sandovsky Method - movement should be
felt at least 2x every 10 min or an average
of 10-12x in an hour
 Cardiff Method/Count to ten method-
monitor the time interval it takes for the
mother to feel ten fetal movements – it
should occur within 60 mins or 1 hour.