PRELIMS

NCMA 217: MATERNAL AND CHILD NURSING

CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

LESSON OUTLINE 3. Live birth or stillbirth is counted in parity

I. Obstetric Data count.
II. Principles In Identif ying Parity
III. OB Scoring
IV. Naegele’s Rule OB SCORING
V. Mc Donald’s Rule
VI. Bartholomew’s Rule T P A L M
VII. Leopold’s Maneuver
o Term
→ Number of f ull-term inf ants (born 37
OBSTETRIC DATA weeks)

o GRAVIDA (GRAVIDITY) o Pre-term

→ Number of pregnancies regardless of → Number of preterm inf ants (born 20 – 36
duration (even abnormal) weeks)
Primigravida Multigravida Nulligravida
o Abortion
Pregnant f or the A woman who Never been
→ Termination of pregnancy bef ore the age
1st time has 2+ pregnant
pregnancies of viability (less than 20 weeks)

o Number of Currently Living Children

Grandmultigravida o Multiple Pregnancy
→ woman who has had 6+ pregnancies.
NAEGELE’S RULE

o Used f or estimating the expected date of delivery

o PARA (PARITY) (EDD) based on LMP (last menstrual period)
→ Number of pregnancies that have reach o Bases calculation on a woman who has a
viability (20 weeks of gestation) whether o 28-day cycle (most women vary)
the f etus was born alive or not. o The typical gestation period is 280 days (40
weeks)
Primipara Multipara Nullipara o First-time mothers usually have a slightly longer
1 pregnancy 2+ pregnancies Zero
gestation period.
that has that have pregnancies
o Formula:
reached viability reached viability beyond viability
(20 wks), (20 wks),
whether alive or whether alive or
dead at birth dead at birth

Grandmultipara
→ woman who has had 6+ viable deliveries, whether
the f etuses were alive or dead.

o VIABILITY
→ Ability of the f etus to live outside the
uterus at the earliest possible gestational
age.

PRINCIPLES IN IDENTIFYING PARITY

1. Number of pregnancies is counted and not

the number of f etuses.
2. Abortion is not included in parity count.
JOHN BENEDICT PASCUAL 1
 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

Formula:
FH x 2/7 = AOG in Weeks

Solution:
FH x 2/7 = AOG
7 cm x 2/7 = 2 MONTHS

BARTHOLOMEW’S RULE

o Use to determine age of gestation by proper

location of f undus at abdominal cavity

MC DONALD’S RULE

o Use to determine age of gestation in weeks using

FUNDIC HEIGHT

o FORMULA:
→ AOG in WKS = FUNDIC HEIGHT x 8/7
→ AOG in MONTHS = FUNDIC HEIGHT x
2/7

• < 12 weeks = not palpable/pelvic cavity

→ Example:
• 3 months = above symphysis
Ms. Johnson’s f undic height is 7 cm. How
f ar along she is? • 5 months = level of umbilicus
• 7 months = bet. Umbilicus and xyphoid
AOG in Weeks • 9 months = touching/below xyphoid
• 10 months = level of 9 months due to lightening;
Given: about 4 cm
FH = 7 cm
LEOPOLD’S MANEUVER
Formula:
FH x 8/7 = AOG in Weeks

Solution:
FH x 8/7 = AOG
7 cm x 8/7 = 8 WEEKS

AOG in Months

Given:
FH = 7 cm

JOHN BENEDICT PASCUAL 2

 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

Maneuver + Rationale Signs → The society and culture in which she

If palpated a round, hard, lives as an adult.
and movable → Whether the pregnancy has come at a
1st BREECH presentation good time in her lif e
- to determine the fetal
presentation/lie through If palpated round, soft and
f undal palpation immovable
HEAD/CEPHALIC o Social Influences
presentation
If smooth hard and From the Past Today
2nd resistant surf ace Pregnancy is viewed as
- to determine the back of FETAL BACK
The pregnancy was a healthy span of time
f etus to hear the fetal
heart sound If angular nodulations
conveyed as a 9- best shared with
KNEES AND ELBOWS month long illness supportive partner and
If the presenting part is or family
movable The pregnant woman The woman brings their
NOT ENGAGED
went alone to a families for prenatal
3rd
If the presenting part is
physician’s office for care visits as well as to
- to determine the degree care watch the birth
immovable
of engagement by
ENGAGED The woman chooses
palpating the lower
uterine segment At the time of birth, what level of pain
HARD: HEAD
she was separated management they want
SOFT, GLOBULAR, from her family to use for labor and
LARGE: BUTTOCKS birth
4th The woman was
- to determine the fetal
hospitalized in
attitude – relationship of
f etus to each part or
seclusion from visitors
Full Flexion and even from the new They expect to
degree of f lexion by
if the f etal chin touches baby for 1 week
grasping the lower
chest
breastfeed their
quadrant of abdomen. It afterward so the newborn
is done only if the fetus newborn could be fed
is in cephalic by nurses
presentation.

The woman and her partner f eel during pregnancy and

PSYCHOLOGICAL CHANGES OF PREGNANCY
prepared to meet the challenges are related to them:
o Pregnancy is such a huge change in a woman’s
→ Cultural background
lif e and brings about more psychological changes
than any other lif e event beside puberty. → Personal belief s
→ Experiences reported by f riends and
relatives.
o A woman’s attitude towards a pregnancy
→ Current plethora of inf ormation available
depends a great deal on psychological aspects
such as: Nurse’s Role

→ The environment in which she was 1. Teaching the woman about their health care
raised. option.
→ The messages about pregnancy her 2. Continue to work with other health care provider
family communicated to her as a child. to “demedicalize” childbirth.

JOHN BENEDICT PASCUAL 3

 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN
o Cultural Influence
• Cultural belief s and taboos can place
restrictions on a woman’s behavior and
activities regarding her pregnancy.
• During prenatal visits, ask the woman
and her partner if there is anything, they
believe that should or should not be
done to make the pregnancy successf ul
and keep the f etus healthy.
• Examples:
→ Lif ting the arms over the head
during pregnancy will cause the
cord to twist.
→ Watching a lunar eclipse will
cause a birth def ormity.
Nurse’s Role:
1. Supporting these belief s shows respect f or the
individuality of a woman and her knowledge of
good health.
2. Find a compromise that will assure a woman
that these are not really harmf ul to a f etus but
that still respects these belief s.
o Family Influences
• The f amily in which woman raised can
be inf luential to her belief s about
pregnancy.
• Woman and her siblings were loved and
seen as a pleasant outcome is more
likely to have a positive attitude
towards her pregnancy.
• A woman who views mothering a
positive activity is more likely to be
pleased when she becomes pregnant
than one who does not value mothering.
• Negative Inf luences - woman and her
siblings were blamed f or the breakup of
a marriage or a relationship.
o Individual Differences
• A woman’s ability to cope with or adapt
to stress plays a major role in how she
can resolve any conf lict and adapt:
a. To being a mother without
needing mothering, to loving a
child as well as partner.
b. To becoming a mother f or each
new child depends on her basic
temperament on whether she
adapts to new situations quickly
or slowly, whether she f ace
them with intensity or maintain a
low-key approach, and whether
she had experience coping with
change and stress.
c. The extent to which a woman
f eels secure in her relationship
with the people around her
d. Past experiences inf luence on
how woman perceive pregnancy
as a positive or negative
experience.
e. To being concerned about her
appearance.
f. To being worried that pregnancy
will rob her f inancially and ruin
her chances of job promotion.
Nurse’s Role
1. Assessing and counselling pregnant woman
2. Fill the role of an attentive listener.
o Partner’s Adaptation
• The more emotionally attached a partner is to a
pregnant woman, the closer the partner’s
attachment is apt to be to the child.
o Factors that af f ect the pregnant woman’s
decision making:
a. Cultural background
b. Past experience
c. Relationships with the f amily members
JOHN BENEDICT PASCUAL 4
 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN
PSYCHOLOGICAL TASKS OF PREGNANCY
FIRST TRIMESTER: ACCEPTING THE
PREGNANCY
Task
Accepting the pregnancy - woman and partner both
spend time recovering f rom shock of learning they are
pregnant and concentrate on what it f eels like to be
pregnant. A common reaction is ambivalence or
f eeling both pleased and not pleased about the
pregnancy.
The Woman
● Accept the reality of the pregnancy, later will come
the task of accepting the baby, f ollowing their initial
surprise women of ten experience the f eeling of
ambivalence
● Ambivalence – ref ers to the interwoven feelings of
wanting and not wanting feelings which can be
conf using to an ordinarily organized woman
● Most women who were not happy about being
pregnant at the beginning are able to change their
attitude towards their pregnancy by the time they feel
the child move inside
● Woman of ten comment af ter such visit they f eel
“more pregnant” or it makes a f irst visit more than an
ordinary one
● Early diagnosis is important because the earlier a
woman realizes she is pregnant, the sooner she can
begin to saf eguard f etal health by discontinuing all
drugs not prescribed or approved by her health care
provider.
Health Care Plan
1. Routine sonogram – to assess f or growth
anomalies and can be a major step in
promoting acceptance because women can
see a beating heart or f etal outline or can learn
the sex of their f etus.
2. First prenatal visits - hearing their pregnancy
of f icially diagnosed at a f irst prenatal visit is
another step toward accepting a pregnancy
The Partner
● All partners are important and should be encouraged
to play a continuing emotional and supportive role in
pregnancy
● Accepting the pregnancy f or a partner means not only
accepting the certainty of the pregnancy and the reality
of the child to come but also accepting the woman in
her changed state
● Partner may also experience f eeling of ambivalence
● Partner may f eel proud and happy at the beginning
of pregnancy
● Soon begin to f eel both overwhelmed with what the
loss of salary will mean to the f amily if the woman has
to quit work
● Feeling close to jealousy of the growing baby who
although not yet physically apparent, seems to be
taking up a great deal of the woman’s time and thought
Health Care Plan
o Prenatal visit or f etal testing – provide an outlet
f or both male and f emale partners to discuss
concerns and of f er parenting inf ormation.
SECOND TRIMESTER: ACCEPTING THE BABY
Task
Accepting the baby - Woman and partner move
through emotions such as narcissism and
introversion as they concentrate on what it will feel
like to be a parent. Roleplaying and increased
dreaming are common
The Woman
● Psychological task of a woman is to accept she is
having a baby, a step up f rom accepting the pregnancy
● The change usually happens at quickening or the f irst
moment a woman f eels f etal movement.
● Woman who caref ully planned the pregnancy, this
moment of awareness may occur soon as she recovers
f rom the surprise of learning she has actually
conceived
● She announces the news to her parents and hear
them express their excitement and see a look of pride
on her partner’s f ace
● A good way to measure the level of a woman’s
acceptance is to measure how well she f ollows prenatal
instructions
The Partner
● A partner may become overly absorbed in work,
striving to produce something concrete on the job that
may limit the amount of time a partner spends with
f amily
● Some men have dif f iculty enjoying the pregnancy
because they have been misinf ormed about
sexuality, pregnancy, and women’s health.
JOHN BENEDICT PASCUAL 5
 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

THIRD TRIMESTER: PREPARING FOR common changes may occur, so they’re

PARENTHOOD not alarmed if they appear:
Task
Preparing for the baby and end of pregnancy - 1. Grief
Woman and partner prepare clothing and sleeping 2. Narcissism
arrangements f or the baby but also grow impatient with 3. Introversion versus Extroversion
pregnancy as they ready themselves f or birth 4. Body image and Boundary
The Woman & The Partner 5. Stress
● Couples begin “nest building” activities (Planning the
6. Depression
inf ant’s sleeping arrangements, choosing a name for
the inf ant, ensuring saf e passage) by learning about
birth o The Confirmation of Pregnancy
→ A medical diagnosis of pregnancy serves
● Couples are usually interested in attending prenatal to date when the birth will occur and
classes and or classes on preparing f or childbirth. helps predict the existence of a high-risk
status.
● Childbirth education class and or preparing for → Pregnancy was diagnosed on symptoms
parenthood can not only help a couple accept but also reported by a woman and the signs
expose them to other parents as a role model who can elicited by a health care provider.
provide practical inf ormation about pregnancy a
concern childcare.

SIGNS AND SYPTOMS OF PREGNANCY

o Assessing Events That Could Contribute to
PRESUMPTIVE SIGNS (SUBJECTIVE SYMPTOMS)
Difficulty Accepting Pregnancy:
f indings in connection with the body system in which
they occur and are experienced by the woman but
1. Pregnancy is unintended.
cannot be documented by an examiner.
2. Learning the pregnancy is a multiple, not a single SIGNS
one. ✓ Breast changes – f eelings of tenderness,
3. Learning the f etus has developmental f ullness, tingling, enlargement and darkening
abnormality. of areola.
4. Pregnancy is less than 1 year af ter the previous
one. ✓ Nausea and vomiting – on arising or when
5. Family has to relocate during pregnancy f atigue.
(Involves a need to f ind new support people.
6. The main f amily support person suf f ers a job loss. ✓ Amenorrhea – absence of menstruation
7. The woman’s relationships end because of
partner’s inf idelity. ✓ Frequent urination – sense of having to void
more of ten than usual.
8. There is a major illness in self , partner, or a
relative.
✓ Fatigue - general f eeling of tiredness
9. Complications of pregnancy occur (Hypertension)
10. The woman has a series of developing ✓ Uterine enlargement – uterus can be palpated
experiences (f ailure in schoolwork). over symphysis pubis.

✓ Quickening - f etal movement f elt by woman.

o Emotional Responses That Can Cause
Concern in Pregnancy ✓ Linea Nigra – line of dark pigment f orms on the
abdomen
• Emotional responses and common
✓ Melasma – dark pigmentation f orms on f ace
reactions helpf ul to caution a pregnant
woman and her partners that the

JOHN BENEDICT PASCUAL 6

 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

✓ Striae Gravidarum) -red streaks f orms on PHYSIOLOGIC CHANGES OF PREGNANCY

abdomen
PROBABLE SIGNS (OBJECTIVE SYMPTOMS) o Reproductive System Changes
f indings and can verif ied by an examiner.
→ Uterine Changes – increase the size of
Laboratory Tests – blood serum and urine specimen to the uterus to accommodate the growing
detect the presence of human chorionic gonadotrophin f etus. The uterus increases in length,
(hCG) depth, width, weight, wall thickness and
SIGNS volume
✓ Chadwick’s sign - color change of the vagina • Length – f rom 6.5 - 32 cm;
f rom pink to violet • Width – f rom 4cm to 24 cm;
• Weight - increases f rom 50g to
✓ Goodell’s sign – sof tening of the cervix.
1000g;
✓ Hegar’s sign - sof tening of the lower uterine • Depth- increases f rom 2.5 cm to
segment. 22 cm
• Uterine wall thickens f rom 1cm to
✓ Sonographic evidence of gestational sac 2cms
• Volume – increases f rom 2 ml. to
✓ Braxton Hick’s contraction – periodic uterine more than1,000 ml.can hold a
tightening total of 4000g at term (7-lb (3.175
g.) f etus, 1,000 ml. amniotic f luid
✓ Fetal outline f elt by examiner through
palpation.
→ Fundus height at various week of
✓ Ballottement – the f etus can f eel through pregnancy
bimanual examination.
• 20-22nd week – reaches the level
Lab Tests of the umbilicus
• 36th week – touches the xiphoid
✓ Serum pregnancy test – hCG appear as early process.
as 24 – 48 hrs. af ter implantation and reach a • 38th week – f etal head settles into
measurable level about 50 unit/ml 7-9 days the pelvis.
af ter conception.
• Hegar’s signs – extreme
✓ Urine sample – concentrated such as a f irst
urine in the morning. sof tening of the lower uterine
segment
✓ Home Pregnancy Test -it takes 2-3 mins. to • Ballottement – the f etus can be
complete and have a high degree of accuracy. f elt to bounce or rise in the
amniotic f luid.
✓ Early prenatal care – is the best saf eguard to • Braxton Hick’s contraction
ensure successf ul pregnancy. • Amenorrhea
POSITIVE SIGNS OF PREGNANCY
✓ Sonographic evidence of f etal outline. – f etal
outline can be seen and measure by
sonogram → Cervical changes – becomes more
vascular and edematous.
✓ Fetal movement f elt by examiner.
• Goodell’s sign - sof tening of the
✓ Fetal heart audible – doppler ultrasound reveal cervix.
heartbeat (10th – 12th week of gestation

JOHN BENEDICT PASCUAL 7

 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

→ Vaginal Changes – increase vascularity o Cardiovascular system

of the vagina.
→ 30-50% increase in the total cardiac
• Chadwick’s sign -changes in volume
color f rom light pink to a deep → Physiologic Anemia of pregnancy may
violet occur.
→ Increases heart rate.
→ Ovarian Changes – active production of → Palpitations is common.
estrogen and progesterone → Edema and varicosities of the lower
extremities
o Breast changes
o Gastrointestinal system
→ Feeling of f ullness, tingling or tenderness
because of increased estrogen level → Slow emptying time of the stomach
→ Breast size increase because of the → Nausea and vomiting
growth in mammary alveoli and in fat → Decreased pH of the saliva
deposit → Hemorrhoids is common due to
→ Areola of the nipple darkens, and the constipation, pressure of the uterus, slow
diameter increases f rom about 3.5 cm peristalsis.
(1.5 inches) to 5cm or 7 cm (2 or 3
inches) o Urinary System

o Endocrine changes → Glomerular Filtration rate increases

→ BUN and Plasma Creatinine decreases
→ Increased thyroid and parathyroid → Renal threshold f or sugar decreases
hormone production → Frequent urination in 1st trimester,
→ Palmar erythema normalizes in 2nd trimester, f requent
→ Insulin production is decreased early urination in 3rd trimester.
during pregnancy and increases af ter the
1st trimester. o Muscular system
→ Prolactin, Melanocyte-stimulating
hormone, and human growth hormone of → Calcium and Phosphorus needs are
the pituitary gland increase, increased.
→ ESTOGEN AND PROGESTERONE → Gradual sof tening of the pelvic ligaments
produced. → Wide separation of the symphysis pubis
→ Placenta as a transient endocrine organ
→ Colostrum can be expelled as early as o Immune system
16 weeks.
→ Increase vascularity. → IgG production decreases
→ Enlarge and protuberant nipples. → WBC simultaneously increases

RECOMMENDED WEIGHT GAIN DURING

o Respiratory system
PREGNANCY
→ Shortness of breathing is common. o A weight gain of 11.2 to 15.9 kg (25 to 35 lb) is
→ Marked congestion or stuf f iness – due to recommended as an average weight gain in
increase estrogen. pregnancy.

o Weight gain in pregnancy occurs f rom both f etal

growth and accumulation of maternal stores and
occurs at approximately 0.4 kg (1 lb) per month

JOHN BENEDICT PASCUAL 8

 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

during the rst trimester and then 0.4 kg (1 lb) per

week during the last two trimesters (a trimester
pattern of 3-12-12).

o As a general rule, in the average woman, weight

gain is considered excessive if it is more than 3
kg (6.6 lb) a month during the second and third
trimesters; it is less than usual if it is less than 1
kg (2.2 lb) per month during the second and third
trimesters.

o Women can be assured that most of the weight

gained with pregnancy will be lost af terward .

o To ensure adequate f etal nutrition, advise women

not to diet to lose weight during pregnancy.
Weight gain will be higher f or a multiple
pregnancy than f or a single pregnancy. You can
encourage women pregnant with multiple f etuses
to gain at least 1 lb per week f or a total of 40to 45
lb.

o Sudden increases in weight that suggest f luid

retention or polyhydramnios (excessive Amniotic
f luid) or a loss of weight that suggests illness
should be caref ully evaluated at prenatal visits.

JOHN BENEDICT PASCUAL 9

 PRELIMS
NCMA 217: MATERNAL AND CHILD NURSING
CARE OF THE MOTHER DURING THE PERINATAL PERIOD
Week 5
PROFESSOR: MA’AM LIZA VICTORIA RAMOS, RN

JOHN BENEDICT PASCUAL 10