Unit 11.2 - Assessment in Pregnancy

Obstetrical History

Gravidity/Gravida - number of pregnancies of any length.

Parity/Para - number of pregnancies carried > 20 weeks.

Term - number of pregnancies carried to full term (38-42 weeks).

Preterm - number of pregnancies carried/delivered preterm (20-37 weeks).

Abortions - number of pregnancies lost prior to 20 weeks gestation; both spontaneous (miscarriage) and therapeutic abortion.

Living Children - current living children.

Subjective (Presumptive) Changes

Symptoms experienced by the pregnant client suggestive of pregnancy; can be caused by conditions other than pregnancy.

Includes: nausea and vomiting, excessive fatigue, urinary frequency, breast changes.

Diagnostic (Positive) Changes

Signs that are completely objective and caused only by pregnancy.

Includes: detection of fetal heartbeat, detected fetal movements.

Pregnancy Terms

Trimesters - 0-12 weeks, 13-26 weeks, 27-40 (± 2) weeks.

Antepartum (Prenatal) - last 20 weeks of pregnancy.

Intrapartum - during labour.

Postpartum - ≈ 6 weeks after birth.

Due Date Calculation

Nägele’s Rule: take first day of last menstrual period, add 9 months, add 7 days.

Ultrasounds

Dating Ultrasound - between 11-14 weeks to determine the estimated due date.

Anatomic Ultrasound - between 18-20 weeks to check for any abnormalities.

Physiologic/Anatomical Changes

• Cardiovascular/Hematological

  • Increased blood volume and cardiac output

  • Supine hypotension

• Respiratory

  • Increased oxygen consumption and tidal volume

  • Displacement of diaphragm leading to shortness of breath

• Endocrine

  • Increased BMR

  • Increased estrogen enlarges uterus, breasts, and genitals

• Gastrointestinal

  • Changes in taste/smell

  • Decreased muscle tone

  • Peristalsis leading to constipation

  • Morning sickness

• Musculoskeletal

  • Muscle cramps

  • Increased abdominal size

• Integumentary

  • Striae gravidarum (stretch marks)

  • Increased estrogen leading to oiliness and acne

Prenatal Visits Frequency

Every 4-6 weeks until 30 weeks.

Every 2-3 weeks until 36 weeks.

Every 1-2 weeks until 36 weeks.

Check: BP, uterine size, urine for protein and glucose, fetal HR.

Supine Hypotensive Syndrome

Decreased venous return when supine leads to hypotension and bradycardia in some pregnant women.

Left lateral is optimal.