Unit 2

Topic 2.2
PRENATAL CARE
Nagele’s Rule

This is how we calculate EDD (Estimated

due date)
 Calculated from first day of LNMP
 Add 7 days and subtract 3 months or/
 Add 7 days and add 9 months.
Nagele’s Rule

• Jane’s LNMP was 2nd February, 2019

• EDD ? November 9th
• Mary’s LNMP was 28th December, 2019
• EDD? Oct 4, 2020
• What other way might we determine
due date? Ultrasound
• What if today was the first day of last
known menstrual period?
Gravida & Parity

 GRAVIDA: Pregnant; how many

pregnancies including the current one
 PARITY: the number of pregnancies that
have reached 20 weeks of gestation
(not the number of fetuses). Twins is
one. You do not count current
pregnancy
 ABORTION: Therapeutic / spontaneous
 VIABILITY: 22-25 weeks
Gravida & Parity

• Jane is 28 weeks pregnant. This is her

third pregnancy. She delivered her first
child at full term, and she has had a
miscarriage at 19 weeks. How would
this be documented?
 Sarah is 32 weeks gestation with
her 3rd pregnancy. She has a 5
year old girl, and has two
rambunctious twin boys at home.
What is her Gravida and Parity?
 Prenatal Care

Importance of Prenatal Care:

•Essential for mother and babe for safe birth
• Essential for mother and babe for safe birth
•Reduces risk of complications
• Monitoring fetal wellbeing and development
• Providing education about pregnancy and post-natal care
for mom and babe
•Woman to practice optimal self management
• In Canada, Approx. 95% of women received care in the
first trimester
 Prenatal Visits

Preconception – Nutritional counselling, if older than 35-

genetic concerns may be discussed.
What is important to discuss in this visit?
lifestyle, alcohol, drugs, smoking, support, spiritual beliefs,
health history (Surgery, HTN, Cancer, diabetes)
FIRST VISIT – as soon as woman thinks she is pregnant.
Baseline data obtained, History, physical assessment & lab
work.

Schedule-1 x monthly until 28 weeks; 2

x monthly until 36 weeks; Weekly until
birth
 Components of First Visit
Health history

– Obstetric/gynecological History
– Para, Gravida
– Men. History
– LMP to calculate EDD
– Infections / STI history
– Medical History
– Family history of genetic factors
– Disease processes in family (like diabetes)
– Nutritional History
– Who is at risk
 Components of First Visit

– Medication History
– Current meds, including OTC
– Prenatal vitamins
– Nicotine's /ETOH / Recreational drugs
– Family History
– Anything that might impact or effect the
current pregnancy
– Psychosocial History
 Components of First Visit
Physical Examination:
•Review of body systems
•Baseline height/weight
•Vital signs
• BP is important
•Assessment of body systems
• This should include an assessment of
general appearance and mental status
• Also looking for signs of partner abuse
•Measurement of SFH and fetal heart sounds
•Pelvic exam (done by physician or midwife)
 Recommended weight gain
in pregnancy
 This is dependant on Pre-pregnancy BMI
 BMI < 18.5 (underweight) 28 – 40 lbs
 BMI 18.5 – 24.9 (normal) 25 – 35 lbs
 BMI 25.0 – 29.9 (overweight) 15 – 25 lbs
 BMI > 30.0 (obese) 11 – 20 lbs
 Components of First Visit
Laboratory Tests
• Blood typing (Rh
factor)  STI screening
• CBC  Genetic Screen
• Hgb, WBC, RBC  Who do we offer
• HIV Screen this to? If history
• Urinalysis  Rubella, Varicella,
Hepatitis B
• Dip urine in office
• Glucose tolerance
testing (usually
done at 28 weeks)
 Components of First Visit
continued

Risk Assessment
•What simple assessments can be done by the nurse to assess
for risk factors in the pregnancy?
• Detailed history to provide intervention and make sure
everything is safe as possible
• Past medical history weight gain, PPH, laceration

•Why are we doing a risk assessment?

• To prepare for the pregnancy
 Risk Assessment
• History (already taken)-part of risk
assessment
 Weight, BP, urine
 SFH/abd palpation (Leopold's maneuvers
used to help determine fetal position)
 Glucose screening 28 weeks – gest.
Diabeties
 Group B streptococcus Swab 36-37 weeks
 If transmitted can cause meningitis or
pneumonia or go blind
 Risk Assessment

When pregnant – other tests can be done to

detect genetic disorders
QUAD SCREEN (Maternal serum screen) -(afp:
alphafetoprotein, estriol, hcG, Inhibin-A) 16-18
weeks – downsyndrome and things
Ultrasound
CVS – Chorionic Villus Sampling (10 - 13 weeks)
Amniocentesis (16 weeks)
Amniocentesis

 14 – 16 Weeks
 Chromosomal testing
Chorionic Villus Sampling

 10-13 weeks
 Used to determine
chromosomal abnormalities
 Genetic Screening Tests

 Genetic testing helps to find out if a person’s genes or

chromosomes may be linked to a health condition
 You may want to consider genetic testing if:
 you or your partner is at risk of passing on a genetic condition you
or your partner has a chromosome condition, or have a previous
child has a chromosome condition
 you are over 35
 Follow-Up Visits
 Follow up interview: less intensive than the initial
interview
 Assess parent’s understanding of warning signs
 Bleeding
 Abdominal pain
 Premature labor
 Fetal well being
 Physical Exam
 BP, weight, urine, edema
 Fetal Assessment
 SFH
 Fetal HR (10-12 weeks)
 Movement (MONITOR movements the same time
everyday) EXAM***
 Health Promotion

• Assess client’s health education needs/what does she want to

learn?
• Use strategies that fit with her developmental stage. Eg.
Adolescent versus adult who is 35.
• Assess readiness to learn
• It is important to identify what THEY need to know…not what
you think they need to know
• Assess how client learns best – what strategies would you
use?
 Discomforts of Pregnancy
First Trimester Second trimester
Nausea and/or Skin pigmentation
Vomiting changes
Urinary frequency Heartburn
Fatigue Constipation
Breast Tenderness Varicose Veins
Bleeding Gums Round ligament pain
Nasal stuffiness Hemorrhoids
Leukorrhea Backache/muscle
Emotional status cramps
Discomforts of Pregnancy

Third Trimester
Shortness of breath
Insomnia
Perineal discomfort and pressure
Ankle edema
 Exercise in Pregnancy

Exercise moderately Not the time to try something new

that is more vigorous
Avoid high impact aerobics
Walking and swimming are good
If healthy than can exercise at least 3x/week

Contraindications to exercise in pregnancy include:

incompetent cervix, previous preterm birth, vaginal
bleeding, hypertension, ruptured amniotic sac, small
baby, not growing well

What are some benefits to exercise during pregnancy?

 Documentation
 Start the Alberta Prenatal Record (at first visit)
(triplicate) this gets completed each time the client
comes for a prenatal visit. At 36 weeks she receives a
copy.
 What information will be on this record?
 What assessment information would be important to
report immediately?
Review

 Gina’s LMP was July 2. What is her

EDD?
 Sam’s LMP was June 13. What is her
EDD?
 Joy’s LMP was November 1. What is
her EDD?
Review

 Sam is 19 weeks pregnant for the 4th time. She has

3 children at home. Her first pregnancy she
delivered at 29 weeks, the child is a healthy boy.
The other two were full term. What is her
gravida/parity?
Review

 Alea is 32 weeks pregnant for the 4th time. She has

2 children at home. Her first pregnancy ended at 24
weeks the baby died 15 hours after delivery. What is
her gravida/parity?