REVIEWER – RLE
GPA, GTPALM SYSTEM
Prenatal
TERMINOLOGIES
1. Gravida – the number of times a woman has
been pregnant.
2. Para – indicates the number of deliveries.
3. Primigravida – a woman who is pregnant for
the first time.
4. Primipara – a woman who is giving birth for
the first time.
5. Multigravida – a woman who is /has been
pregnant
6. Multipara – a woman who has had two or more
births. (Twins or triplets)
7. Nullipara – a woman who has never been
pregnant.
8. Abortion – is the loss of pregnancy before the
fetus is capable of living outside the uterus.
9. LMP – last menstrual period.
10. Obstetric – is a branch of medicines defined as
the art & science of caring for the childbearing
woman and her newborn baby.
11. Crowning – stage at which the fetal head can be
seen at the vaginal orifice.
12. IUFD – Intra Uterine Fetal Death formerly
known as still birth.
13. Polyhydramnios – excessive amount of
amniotic fluid.
• GPA system focuses on the woman’s delivery.
Ex: G2P1
• Gravida – the number of pregnancy.
• Para – the number of delivery.
• Term – the total number of infants born @ term
37 or up to 42 weeks.
• Preterm – total number of infants born before
37 weeks.
• Abortion – the total number of spontaneous &
induced abortion; pregnancy that did not reach
the age of viability (<20 weeks AOG or <400g)
• Living – total number of children currently
living.
• Multiple pregnancies – the total multiple
pregnancies (i.e., twins, triplets are counted as
one)
Nursing Health History
- Estimation of EDC, AOG, LMP, FH,
Naegele’s Rule
- Determining the Last Menstrual Period
(LMP)First day of last menstruation.
Example: Last menstruation= June 14-18, 2008
LMP: June 14, 2008
Naegele’s Rule
- Determining the Expected date of delivery
(EDC)
For LMP between April to December:
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  3 (months) +7 (days) +1 (Year) i) Uterus becomes globular and drops
= 40 weeks AOG
For LMP between January to March:

 9 (months) +7 (days)

- Determining the Age of Gestation PHYSICAL ASSESSMENT

(AOG) -Number of days since LMP to the present day (LEOPOLD’S MANEUVER)
divided by 7
Purpose: to estimate fetal size, locate fetal parts and
Example: A pregnant woman comes to the clinic for an
determine presentation, position, engagement and
initial prenatal check-up.
attitude
Her LMP was December 16, 2021. Fetal assessment:
Present day is February 14, 2022. • FHR;
December - 15 (31 days – 16 days) • Fetal Movement -Normal
January – 31 • Fetal Heart Tone: 120-160 BPM
February - 14
ANSWER: 60 days / 7 = 8 weeks and 4 days (AOG)
• Number of Fetal movements every 10mins:
2 for every 10 minutes
• Number of Fetal movements every hour:
Mc Donald’s Rule Formula: 10-12 per hour
AOG (months) = Fundic height (in cm) ÷ 4
 FOR 20 WEEKS AOG AND ABOVE:
LM1: FETAL PRESENTATION or FUNDAL
FUNDIC HEIGHT (CM) = AOG (WEEKS)
GRIP
a) Fundus @ symphysis pubis
Finding: Presentation. This maneuver identifies the part
= 12 weeks AOG
of the fetus that lies over the inlet to the pelvis.
b) Fundus between the symphysis pubis &
The common presentations are cephalic (head first) and
umbilicus = 16 weeks AOG
breech (pelvis first).
c) Fundus @ umbilicus
Head = hard, smooth, globular, mobile & ballotable
= 20 – 22 weeks AOG
Breech = soft, irregular, round and less mobile
d) 2 fingerbreadths above umbilicus
= 24 weeks AOG
e) Fundus 28 cm. from top of symphysis pubis =
28 weeks AOG
LM2: FETAL POSITION or UMBILICAL GRIP
f) Midway between the umbilicus & xiphoid
process = 30 weeks AOG Finding: Position
g) Just below the xiphoid process This maneuver identifies the relationship of the fetal
= 34 weeks AOG body part to the front, back or sides of the maternal
pelvis. There are many possible fetal positions.
h) Fundus at lower border rib cage or at the level of
the xiphoid process Back = firm, smooth, convex, resistant
= 36 AOG

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The small parts = (arms & legs) will feel small,
irregularly placed and knobby may be actively or
possible mobile.

• “Peri-care” or “Perineal –genital care”

LM3: FETAL ENGAGEMENT or PAWLIK’S
GRIP
Finding: Presenting Part
This maneuver identifies the most dependent part of the
fetus that is, the part that lies nearest the cervix.
As she exhales, sink your fingers down slowly and
deeply around the presenting part. Note the contour, the
size and consistency of the part.
• Involves cleansing of client’s external genitalia,
anal area and surrounding skin, with soap and
water, water alone or in combination with any
commercially prepared peri-wash.
PURPOSE
1. To prevent or eliminate infection, odor and
promote healing.
2. Remove secretions and provide comfort.

The head will feel hard, smooth, and mobile if not

engaged. Immobile if engaged.
The breech will feel soft and irregular.

LM4: FETAL ATTITUDE or PELVIC GRIP

Finding: Cephalic Prominence
This maneuver identifies the greatest prominence of the
fetal head palpated over the brim of the pelvis.
When the head is flexed. The forehead forms the
cephalic prominence.
When the head is extended, the occiput becomes the
cephalic prominence
PRINCIPLE
• Observe infection control throughout the
procedure for your own and patient’s
protection(forceps/gloves)
• Protect patient from danger of cross
contamination
• Procedures maybe embarrassing to both the
Nurse and the patient. Maintain straight forward
attitude and respect for privacy (professional).
Draping.
• Do procedure in dorsal recumbent position with
head of the bed elevated. (Easy exposure of
perineum)

SPECIAL CONSIDERATIONS

Perineal Care Page 3|4

1.Test the water before pouring into the perineal area.
2. Observe medical aseptic technique throughout the
procedure.
3. Prepare all materials needed before the procedure

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