Lab 4 Edd, Gpal Score, Common Terminologies 2023-24 1ST Sem MS Preetha

LAB SESSION 4
ASSESSMENT OF ANTENATAL
MOTHER
PREPARED BY: MS BINITHA RANI
MODIFIED BY : MS PREETHA AJITH KUMAR
Objectives:
1. Discuss the concepts of the new ANC model
2. Demonstrate the process of booking in ANC according to
MOH
3. Discuss the nursing care during subsequent prenatal visits.
4. Determine estimated date of delivery
5. Explain daily fetal movement count (Kick counts)
6. Describe Ultrasonography for antenatal women
7. Demonstrate skills in administering deltoid injections
8. Demonstrate a systematic physical assessment of the
pregnant woman.
9. Conduct abdominal assessment of pregnant woman
through utilization of Leopold‘s Maneuvers.
SLIDES FROM : Ms Binitha
Preetha/Binitha/maternal nursing 2
Today’s objectives
1. Determine estimated date of delivery by
Nagele’s Rule
2. Calculate Obstetric Score
3.Common terminologies related to pregnancy
4.Understand McDonald’s Rule to identify fetal growth
Time allotted – 2 hrs

Common terminologies related to pregnancy
• Last menstrual period(LMP):

Date of the first day of the last menstrual period before
pregnancy. This date is used for the calculation of the
date that the baby should be born.
➢ PREGNANCY (Gestation):
Pregnancy the time from the last menstrual period until
birth of a baby.
EXPECTED DATE OF DELIVERY (EDD)
CALCULATION
• Calculate EDD( expected date of delivery) or EDC
( expected date of confinement) About 280 days from LMP by
using
NAEGELES’S RULE
ADD 9 MONTHS and 7 DAYS to the date of the LMP
EDD or EDC = (LMP+ 9 Months)+ 7 Days
OR
EDD = Count 3 months back from the First day of her
last normal menstrual period & add 7 days
Calculate EDD
• LMP : 4 January 2023
EDD or EDC = ( LMP+ 9 Months)+ 7 Days
EDD= (4 January 2023 + 9 months )+ 7 days

= 4 October 2023 +7 days
EDD = 11 October 2023
Calculate EDD
LMP : 4 February 2023
EDD :11 November 2023

5
LMP : 19 October 2022
EDD: 26 July 2023
LMP: 26 June 2023
EDD: 2 April 2024

Contd.(Assignment)
• LMP 6 JANUARY 2023

• LMP 10 APRIL 2O23
• LMP 17 NOVEMBER 2022
• LMP 20 FEBRUARY 2023
• LMP 08 JULY 2022
• LMP 27 JUNE 2023
• LMP 26 AUGUST 2022
Contd.
Gestational Age :
The number of weeks the fetus remained in
uterus from last menstrual period.
Gravida:
Number of times a women has been
pregnant, including the present pregnancy,
abortion and still birth.
Note : In multiple pregnancy even though
she is pregnant with more than one baby ,
gravida is counted as one.
Contd.
Primigravida:
A woman who is pregnant for the first time.
Multigravida:
A woman who is in pregnant for the second or any
subsequent pregnancies.
Trimester :
A period of 3 months during pregnancy ,
• The 1st trimester is 1-12 weeks ( 1 to 3 months)
• The second trimester is 13-24 weeks ( 4- 6 months)
• The third trimester is 25-weeks to delivery.
(7 months to delivery)
Contd.
Parity:
Is defined as the number of times a woman
has given birth to a fetus with a gestational
age of 24 weeks or more, (excluding
abortions)regardless of whether the child was
born alive or was stillborn.
Note: In multiple pregnancy even though she
is delivering more than one baby, parity is
counted as one.
Contd.
Primipara :
woman who has delivered one child (>24weeks) regardless
of the outcome (alive or still birth)
Multipara :
A pregnant woman who has delivered more than one
child(>24weeks) regardless of the outcome (alive or still
birth)
Grand Multipara:
one who has given birth to five or more children
( >24 weeks)regardless of outcome ( alive or still birth)
Contd.
 Abortion:
Birth that occurs before 24 weeks of gestation
 Living :
Number of living children for the pregnant woman
Note : in case of twins will be counted as two and triplets 3
and so on.
 Stillbirth:
 Fetus born dead after 24 weeks of gestation.
Contd.
• Puerperium:
• The period after completion of the third stage of
labor until involution of the uterus is complete
usually 6 weeks.
 After pains:
Cramp like pain due to contractions of the uterus
that might occur after childbirth. They are more
common in multi-paras, tend to be most severe
during nursing, and lasts 2 to 3 days.
OBSTETRIC SCORE :( G P A L )
 GRAVIDA : Denotes by ‘G’
 PARA : Denotes by ‘P’
 ABORTION : Denotes by ‘A’
 LIVING : Denotes by ‘L’
 STILL BIRTH : fetus born dead after 24 weeks of

gestation (Counted as parity)
OBSTETRIC SCORE :
• Ms. Rahma 28 yrs old 36 wks pregnant lady
is attending antenatal clinic.she is having 4
healthy living children. calculate obstetric
score.
Answer
Gravida (G) = Pregnant now + 4 children in
4
pregnancies
=1+4=5
Parity (P) = 4 children in four deliveries
= 4
Abortion (A) = Birth that occurs before 24
weeks of gestation
= 0
Living (L) = 4 children
=4 Preetha/Binitha/maternal nursing 19
OBSTETRIC SCORE :
G5 P4 A0 L4
Scenario 1
• Ms.Fatma 23 yrs old 32 wks pregnant lady is

attending antenatal clinic.She is having 3 healthy
living children she is having history of an abortion
at 16 weeks.Calculate the obstetric score.
G5 P3 A1 L3
Scenario 2
• Ms.Habiba 36 weeks of pregnancy is admitted in

antenatal ward. Her previous two pregnancies
terminated at 16 and 14 weeks respctively.Calculate
the obstetric score.
G3 P0 A2 L0
Scenario 3
Ms.Sara 28 yr old lady 36 weeks pregnant, is attending

ANC.She is having 5 living children with one set of
twin Calculate the obstetric score.
G5 P4 A0 L5
Scenario 4
• Ms Jolly 27 year old admitted in labor room with

labor pain, she is 39 weeks of gestation,having one
living child and she has history of two abortions in
the first trimester. Calculate the obstetric score.
G4 P1 A2 L1
Antenatal assessment
I. Common terminologies
related to abdominal
examination
Lie:
• Relationship of the long axis of the fetus and
long axis of the pregnant woman.
• The fetal lie may be longitudinal, transverse,
or oblique.
LIE: (Fetal lie)
• Relationship of the long axis of the
fetus and long axis of the pregnant
woman.
• The fetal lie may

• Longitudinal
• Transverse
• Oblique
Types of lie
• Longitudinal lie:
• Oblique lie :
• Transverse lie:
Longitudinal lie
When the long

axis of mother is
lying parallel
( vertical) to the
long axis of fetus.
Longitudinal lie in cephalic presentation Longitudinal lie in
Breech presentation
Oblique lie :
When the long axis

of fetus is lying
diagonally across
the long axis of
mother.
Transverse lie
When the long axis of
fetus is lying
horizontal
(transverse) to the
long axis of mother.
Preetha/Binitha/maternal nursing Oblique Lie

31
Fetal lie
Longitudinal lie
Identify the fetal lie
Identify the fetal lie
Attitude
•Refers to the relationship of the fetal

part each other
ATTITUDE
•Refers to the relationship of the fetal
part each other A
NORMAL
Attitude Deflexion
Flexion Extension
fetus in good attitude is in complete flexion:
Presentation:
• The fetal body part that enters the maternal
pelvis first.
• The three possible common presentation are
:
1. Cephalic (Vertex)
2. Shoulder
3. Breech.
PRESENTATION:
• “The fetal body part that enters

the maternal pelvis first”.
• The three common

presentation are :
Cephalic
Shoulder
Breech.
Cephalic
PRESENTATION:
• “The fetal body part that enters

the maternal pelvis first”.
• The three common

presentation are :
Cephalic
Shoulder
Breech.
Cephalic
Variations of the Breech presentation
Variations of the cephalic presentation
Identify fetal presentation
Position:
• Relationship of the landmark on the presenting
part (denominator) to a specific quadrant of a
woman’s pelvis.
( front, sides, or back of the maternal pelvis).
Front: Back :
Right anterior Right posterior
Left anterior left posterior
Sides : Right transverse
left transverse
POSITION:
• Relationship of the presenting part
(denominator) to a specific quadrant of a
woman’s pelvis.
( front, sides, or back of the maternal
pelvis).
Front: (ANTERIOR) Back : (POSTERIOR)

Right anterior Right posterior
Left anterior left posterior
Sides : (TRANSVERSE)
Right transverse
left transverse
TYPES 0F FETAL POSITION:
Indicated by ABBREVIATION OF THREE LETTERS
The middle letter denotes fetal landmark.
( O for occiput and S for sacrum)
1. Cephalic presentation : The Occiput, ‘O’

ROA( right occipito anterior) , ROP( right occipito
posterior) ,LOA( left occipito anterior) ,LOP(left
occipito posterior)
2. Breech presentation: The Sacrum, ‘S’
LSA( Left sacro anterior),LSP ( Left sacro posterior),

and RSA ( Right sacro anterior), , RSP ( Right sacro
TYPES 0F FETAL POSITION:
Indicated by ABBREVIATION OF THREE LETTERS
The middle letter denotes fetal landmark.
( O for occiput, M for mentum and S for sacrum)
LANDMARK
1. Cephalic presentation : The Occiput, ‘O’
POSITION: ROA ,ROT, ROP &
LOA,LOT, LOP
2. Breech presentation: The Sacrum, ‘S’
POSITION: LSA,LST,LSP &
RSA ,RST,RSP
3. Face presentation: The Chin, ‘M’
(mentum)
POSITION: LMA,LMT,LMP &
RMA,RMT,RMP Preetha/Binitha/maternal nursing 53
FETAL POSITIONS
FETAL POSITIONS
ENGAGEMENT
• The widest part
of the fetus
(the biparietal diameter in a cephalic
presentation; intertrochanteric diameter in
a breech presentation)
• has passed through the pelvis inlet.
(The settling of the presenting

part of a fetus far enough into
the pelvis to be at the level of
the ischial spines, a midpoint of
the pelvis)
FUNDAL HEIGHT- Mc Donald’s rule:
• After 12 weeks palpate the fundus from the notch above
the symphysis pubis to superior aspect of the uterine
fundus.
• Uterus palpable over the symphysis pubis by 12 weeks.
• Reaches the umbilicus at 20 ( 20 -22) weeks.
• Reaches the xiphoid process at 36 weeks.
• Often return 4 cms below the xiphoid at 40 weeks (
because of lightening).

Lab 4 Edd, Gpal Score, Common Terminologies 2023-24 1ST Sem MS Preetha

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LAB SESSION 4

Time allotted – 2 hrs

• Last menstrual period(LMP):

EDD or EDC = (LMP+ 9 Months)+ 7 Days

EDD or EDC = ( LMP+ 9 Months)+ 7 Days

EDD= (4 January 2023 + 9 months )+ 7 days

LMP : 4 February 2023

EDD :11 November 2023

LMP : 19 October 2022

EDD: 26 July 2023

EDD: 2 April 2024

• LMP 6 JANUARY 2023

 PARA : Denotes by ‘P’

 ABORTION : Denotes by ‘A’

 LIVING : Denotes by ‘L’

 STILL BIRTH : fetus born dead after 24 weeks of

• Ms.Fatma 23 yrs old 32 wks pregnant lady is

• Ms.Habiba 36 weeks of pregnancy is admitted in

Ms.Sara 28 yr old lady 36 weeks pregnant, is attending

• Ms Jolly 27 year old admitted in labor room with

• The fetal lie may

When the long

When the long axis

Preetha/Binitha/maternal nursing Oblique Lie

•Refers to the relationship of the fetal

fetus in good attitude is in complete flexion:

• “The fetal body part that enters

• The three common

• “The fetal body part that enters

• The three common

Front: (ANTERIOR) Back : (POSTERIOR)

1. Cephalic presentation : The Occiput, ‘O’

LSA( Left sacro anterior),LSP ( Left sacro posterior),

(The settling of the presenting

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