ASSESSMENT OF THE

CHILDBEARING WOMAN
MR. ANDRE CARLO C. DE VEYRA, MAN, RN
• 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, hypertension,
Diabetes mellitus, 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
preaparation)
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 wks, 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 the first

time
• Primipara- a woman who has given birth to one child
past age of viability
• Multigravida- a woman who has been pregnant
previously
• Multipara- a woman who has carried two or more
pregnancies to viability
• Nulligravida- a woman who has never been and is
not currently pregnant
• G- Gravida- the number of times the woman has been
pregnant including the current pregnancy
• T- Full term – children born at 37 weeks or after
• P- Pre term- children born before 37 weeks
• A- spontaneous or induced termination of pregnancy
before the “age of viability”
Age of viability- refers to the age at which a fetus could survive
outside the uterus if they were born, usually at 24 weeks AOG or
when the fetus weighs 400 gm or more
• L- number of Living children
• M- number of multiple pregnancies
• A woman is currently pregnant 20 weeks AOG and has given birth
last 2015 to a healthy baby boy @ 37 weeks AOG and last 2018 to a
healthy baby girl at 38 weeks AOG

G3 P2
G-3 T-2 P-0 A-0 L-2 M-0
or
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
or
G5 30130
• Ana is currently pregnant at 20 weeks AOG, she gave birth to twins at 37
weeks AOG, last 2017 she also gave birth to a baby girl @ 34 weeks AOG

G3 P2

G-3 T-1 P-1 A-0 L-3 M-1

or
G3 11031
• Maria is currently pregnant, she had 4 previous pregnancies, all
delivered full term. The other year her 2 year old baby died due to
an accident

G5 P4

G-5 T-4 P-0 A-0 L-3 M-0

or
G5 40030
Weight:

Pre-pregnancy weight status Allowable weight gain during

the entire pregnancy
Normal weight 25-35 lbs
Over weight 15-25 lbs
Obese 15 lbs
Expected weight gain during pregnancy
• 1st trimester- 2-4 lbs
• 2nd trimester- 11 lbs
• 3rd trimester- 11 lbs
ASSESSMENT OF FETAL GROWTH
& DEVELOPMENT
• A. Naegle’s rule- used to assess the Estimated Date
of Confinement (EDC)/ Expected Date of Delivery
- Based on the LMP, count back 3 mos then add 7
days and 1 year
• Note: You do not add one year if the LMP is from
Jan-Mar
A1.) LMP is Jan 20, 2020- count back 3 months =
October 20+ 7days= October 27, 2020
EDC is October 27, 2020
A2.) LMP is March 3,2020- count back 3 months
=December 3 + 7 days= Dec10,2020
EDC is Dec 10, 2020
NAEGELE’S RULE
JAN 20 2020
+ 7
EDC OCT 27 2020

• Count back 3
months
• Add 7 days LMP

• Do not add 1 year

if LMP is from Jan - Mar
EX. 2

LMP MAR 3 2020 • Count back 3 months

+7 • Add 7 days
EDC DEC 10 2020 • Do not add 1 year if
LMP is from Jan - Mar
A3.) LMP June 5, 2020- count back 3 months= March
5+7 days= March 12, 2021
EDC is March 12, 2021
EX. 3

LMP JUN 5 2020 • Count back 3 months

+7 +1 • Add 7 days
EDC MAR 12 2021 • Add 1 year
A4.) LMP is June 29, 2020- count back 3 months=
March 29 + 7 days= March 36, 2021
Since there is no such date as March 36 we will
subtract 31 which is the total number of days for the
month of March and add 1 month.
EDC is April 5, 2021
EX. 3
• Count back 3 months
LMP JUN 29 2020 • Add 7 days
• Add 1 year
+ 7 +1 • Since there is no such
MAR 36 2021 date as March 36 we
- 31 will subtract 31 which
EDC APR 5 2021 is the total number of
days for the month of
March
• Add 1 month
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
EX. 3
• Count back 3 months
LMP OCT 31 2020 • Add 7 days
• Add 1 year
+ 7 +1 • Since there is no such
JUL 38 2021 date as July 38 we will
- 31 subtract 31 which is
EDC AUG 7 2021 the total number of
days for the month of
July
• Add 1 month
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
Jun- 30
July- 6
168/ 7 (constant)= 24 weeks AOG
B2.) LMP Sept 25, 2019 Date of visit: May 31, 2020
Sept 30-25 =5
Sept - 5
Oct -31
Nov-30
Dec- 31
Jan- 31
Feb- 29 (since 2020 is a Leap Year)
Mar-31
Apr- 30
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
• 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
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
• Bartholomew’s Rule- the AOG is estimated by using the height
of the fundus of the uterus in
correspondence with specific anatomical
parts
General appearance:
A. Head- chloasma (extra pigment on the face)
- Increased hair growth because of the overall
increased metabolic rate - increased melanin
production
B. Eyes- 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 congestion or
appearance of swollen nasal membranes- due to
increased level of ESTROGEN
D. Sinuses- normally tender
E. Ears- 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 . - Cracked corners of the mouth
may indicate Vit. A deficiency
- Pregnant women are prone to tooth decay
because of increased reactivity of the tooth enamel to
bacteria and due to a decrease of pH in the mouth
 - Gingival hypertrophy- due to increased estrogen
stimulation
- Pinpoint lesions with an erythematous base may
indicate herpes infection
G. Neck- there may be slight enlargement of the
thyroid due to an overall increase in metabolic rate
H. Lymph nodes- there must be no palpable lymph
nodes
I. Breasts- increase in size due to hyperplasia of the
mammary alveoli
- Breast areola darkens and widens from 3.5 cm
(prepregnancy) to 5-7.5 cm during pregnancy
 - A secondary areola may develop surrounding the
natural one
- It become 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 baby
Physiologic and Psychological
Changes During Pregnancy
1. Presumptive Signs- those that are least indicative of
pregnancy, taken as single entities, they could easily indicate
other conditions
- largely subjective
a. Breast changes f. Uterine enlargement
b. Nausea and vomiting g. Quickening
c. Amenorrhea h. Linea nigra
d. Frequent urination i. Melasma
e. Fatigue j. Striae gravidarum
2. Probable Signs-
a. Serum laboratory test
hCG- a hormone created by the chorionic villi
in the placenta.
- Reaches a measurable level (50mIU/ml)
7-9 days after conception
 - Peaks at about 100mIU/ml but by the 60th- 80th
day after this it declines again and is no longer
detectable in the serum.

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. Ballotement- 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 han 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- Ballottment 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
Pathologic Retraction Ring/ Bandl’s Ring
Actual picture of Bandl’s Ring
• pH of vaginal secretions decreases from 7 to 4-5 due
to the action of Lactobacillus 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 tubercles) enlarge.
 - 16th week of pregnancy- colostrums is expelled
from the nipples in a form of thin watery fluid which is
high in protein and considered to be a precursor of
breast milk
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
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.
A6. Increased perspiration
A7. Palmar erythema- due to increased estrogen
level in the body
B. Respiratory system
• NO change in vital capacity
• Tidal volume is increased by 30-40 %
• Respiratory rate is increased by 1-2 cpm/minute (18-
20cpm/min)
• 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- halted FSH and LH release because of
increased levels of estrogen and progesterone
- late in pregnancy it produces oxytocin
- produces “prolactin” which prepares the breasts
for lactation
• Thyroid and parathyroid glands- glands enlarges and
BMR increases by 20%
- Protein based-iodine, butanol-extractable iodine,
and thyroxine are all elevated as well.
• Adrenal glands- 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
• Pancreas- increased production of insulin in response
to increased amount of glucocorticoid produced by
the adrenal glands . However insulin are less effective
during pregnancy because of the increase level of
estrogen, progesterone, and hPL which are
antagonists to insulin.
• FBS- 80-85 mg/100ml
TYPES OF PELVIS:
1. Android
2. Anthropoid
3. Gynecoid
4. Platypelloid
Common Measurements
1. Diagonal conjugate- distance between the anterior
surface of the sacral prominence and the anterior
surface of the inferior margin of symphysis pubis
-considered to be the most useful measurement
for the estimation of pelvic size.
 -suggests the anteroposterior diameter of the
pelvic inlet
• Measured while the client is in a lithotomy position
• >12.5 cm- adequate for childbirth (average fetal head
is 9 cm)
2. True conjugate- or conjugate vera- measurement
between the anterior surface of the sacral prominence
and of the posterior surface of the inferior margin of
the symphysis pubis.
 - cannot be measured directly, sobtract the usual
depth of the symphysis pubis (assumed to be 1.2-2
cm) from the diagonal conjugate measurement.
-actual diameter of the pelvic inlet (10.5-11 cm)
3. 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 28th-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