1. NURSING CARE DURING PRENATAL PERIOD
I. ASSESSMENT
A. Nursing Health History
1. Estimation of EDC, AOG, LMP, FH,
Naegele’s Rule, Weight
Determining the Last Menstual Period (LMP)
 First day of last menstruation
Example: Last menstruation=
June 14-18, 2008
LMP: June 14, 2008
Determining the Expected date of delivery (EDC)
A. Naegele’s Rule
 For LMP between April to December:
- 3 (months) +7 (days) +1 (Year)
 For LMP betwen January to March:
+ 9 (months) +7 (days)
Examples:
1. LMP : January 15, 2005
01 15 2005
+ 9 +7
__________________
10 22 2005 (October 22, 2005)
2. LMP : December 16 2004
12 16 2004
-03 +7 +1
__________________
09 23 2005
(September 23, 2005)
Determining the Age of Gestation (AOG)
 Number of days since LMP to the present
day divided by 7
Example:
A pregnant woman comes to the clinic for an
initial prenatal check up. Her LMP was
December 16, 2004. Present day is February
14, 2005.
December - 15 (31 days – 16 days)
January - 31
February - 14
______________________
60 days / 7 = 8 weeks and 4
days (AOG)
 Mc Donald’s Rule
• Formula: AOG (months)= Fundic height
(in cm)÷ 4
E.g. FH of 24 cm
= 24 ÷ 4
= 6 months (24 weeks)
***For 20 weeks AOG and above:
FUNDIC HEIGHT (CM) = AOG (WEEKS)
**For below 20 weeks AOG:
= FH (CM) x 8 / 7
= AOG in weeks
 Bartholomew’s Rule – estimates AOG by
the relative position of the uterus in the
abdominal cavity
2. OB Classification: Gravida; Para;
Full term; Abortion
Obstetrical Scoring (GP TPALM)
 Gravida- number of pregnancy (including
present pregnancy)
 Parity- number of viable pregnancies who
are previously born/ number of viable
deliveries
 Term- number of children born between
37- 42 weeks AOG
 Preterm- number of children born before
the 37th week of gestation
 Abortion- pregnancy that did not reach the
age of viability (> 20 weeks AOG or <
400g)
 Living- number of CURRENTLY living
children
 Multiple Pregnancies- (i.e. twins, triplets
are counted as one)
B. Physical Assessment
1. Leopold’s Maneuver
Purpose: to estimate fetal size, locate fetal parts
and determine presentation, position, engagement
and attitude
LM1: fetal presentation
LM2: fetal position
LM3: fetal engagement
LM4: fetal attitude
AOG Anatomical Landmark:
12 weeks Slightly above the symphysis pubis
20 weeks Level of the umbilicus
36 weeks Below the xiphoid process
32 and 40 weeks Same level due to lightening on the
40th week

2. Position: dorsal recumbent position
Preparation: 1. The client must empty her bladder
30 minutes before examination; 2. Place a small
pillow underneath the client’s hips.
2. Vital signs (BP)/ Weight
3. Fetal assessment: FHR; Fetal Movement
Normal Fetal Heart Tone: 120-160 BPM
Number of Fetal movement every 10 minutes:
2 for every 10 minutes
Number of Fetal movement every hour:
10-12 per hour
*DIAGNOSIS OF PREGNANCY
STAGE PRESUMPTIVE PROBABLE POSITIVE
First
Trimester
Amenorrhea
Morning
sickness
Breast changes
Fatigue
Urinary
frequency
Enlarging uterus
Chadwick’s
signs
Goodell’s sign
Hegar’s sign
Positive HCG
(pregnancy
test)
Elevation of
BBT
Ultrasound
evidence
Second
trimester
Quickening
Increased skin
pigmentation;
(chloasma and
linea nigra)
Striae
gravidarum
Enlarged
abdomen
Braxton Hicks
Contraction
Ballotement
Fetal heart tone
Fetal movement
felt by the
examiner
Fetal outline on X-ray
C. Laboratory tests
Urine
Heat acetic- ALBUMINURIA
Benedict’s tests- GLYCOSURIA
Urinalysis- UTI
Blood
CBC (Hgb, Hct)- ANEMIA
Blood typing
VDRL- SYPHILIS
4. Diagnostic Tests
Ultrasound
 Intermittent ultrasonic waves are transmitted
by an alternating current to a transducer,
which is applied to the women’s abdomen
 Two types:
A. Transabdominal
B. Transvaginal
 Nursing Responsibilities:
1. Drink 1- 1.5 quart of water 2 hours
before the procedure
2. Instruct the client not to void
• Rationale: Fills the urinary bladder and
moves it upward and away from the
uterus; when the bladder is full, the
examiner can assess other structures,
especially the vagina, cervix, in relation
to the bladder
3. Position: Supine
• If the client complains of dizziness or
shortness of breath:
A. Place the patient on side lying
position with towel under hip
B. Elevate the patient’s upper body
during the test to PREVENT
COMPRESSION OF VENA CAVA
Amniocentesis
 It is a procedure used to obtain amniotic
fluid for testing
 The physician scans the uterus using
ultrasound to identify the fetal and placental
positions to identify adequate amount of
amniotic fluids.
 The skin is cleaned with betadine; local
anesthesia at the needle insertion is
optional; gauge 22 needle is then inserted
into the uterine cavity and amniotic fluid is
withdrawn.
 Obtain 15-20 cc of amniotic fluid for
examination
 Should not be done until at least 16 weeks
of gestation
 A. Diagnostic Uses: Provides information on
1. Fetal Health
• Assesses appropriate levels of:
a. Alpha- fetoprotein (AFP)
b. Human chorionic gonadotropin
(HCG)
c. Unconjugated estriol (UE)
• Necessary for detection of DOWN
SYNDROME (TRISOMY 21),
TRISOMY 18, and NEURAL TUBE
DEFECT
2. Fetal lung maturity
• Assesses for:
a. Lecithin/ Sphingomyelin (L/S)
ratio-surfactant
**By 35 weeks AOG, the normal
L/S ratio= 2:1; decrease risk of

3. acquiring Respiratory Distress
Syndrome
b. Phosphatidylglycerol (PG)-
phospholipid in surfactant
**Appears when fetal lung maturity
has been attained at about 35
weeks AOG, must be present to
prevent RDS
3. Genetic disorders
 Nursing Responsibilities:
1. Monitor for the side effects:
• Unusual fetal hyperactivity or lack of
movement
• Clear vaginal discharge/ Bleeding
• Uterine contraction or abdominal pain
• Fever or chills
2. Instruct to engage to LIGHT ACTIVITY
24 HOURS after the test
• Rationale: to decrease uterine irritability
3. Increase fluid intake
• Rationale: to increase utero-placental
circulation and replace amniotic fluid
Contraction Stress Test (CST)
 Means of evaluating the respiratory function
(oxygen and carbon dioxide exchange) of
the placenta
 Identifies the fetus at risk for intrauterine
asphyxia by observing the response of the
FHR to the stress of uterine contractions
(spontaneous or induced)
 Procedure
1. The critical component of CST is the
presence of uterine contractions.
They may occur spontaneously or may
be induced with oxytocin administered
via IV (also known as oxytocin
challenge test). The natural way of
obtaining oxytocin is through nipple
stimulation.
2. An electronic fetal monitor is used to
provide continuous data about the fetal
heart rate and uterine contractions.
3. After 15 minutes of baseline recording
of uterine activity and FHR, the tracing
is evaluated for presence of
spontaneous contractions. If 3
spontaneous contractions of good
quality and lasting 40-60 seconds occur
in a 10 minute window, the results are
evaluated. If no contractions occur or
they are insufficient for interpretation,
oxytocin is administered via IV or the
breasts are stimulated.
 Interpretation
1. Negative (normal/ desired result)
• 3 contractions of good quality lasting
40 seconds or more in 10 minutes
without evidence of late
decelerations
• Implies that the fetus can handle the
hypoxic stress of uterine
contractions
2. Positive (Abnormal result)
• Repetitive late decelerations with
more than 50% of the contractions
• Implies that the hypoxic stress of
contraction causes a slowing of the
FHR
3. Equivocal/ Suspicious
• Non-persistent late decelerations or
decelerations associated with
hyper-stimulation (contractions
frequency every 2 minutes or
duration of longer than 90 seconds
Nonstress Test
 measures the response of the fetal heart
rate to fetal movement
 Instruct the mother to push the button
attached to uterine contraction monitor if
she feels the fetus moves
 Usually done for 10-20 minutes
 What happens to the FHT if fetal movement
occurs?
As the fetus moves, there is an
INCREASE in FHT (15 beats per minute)
and remains elevated for 15 seconds
 Results and Interpretation:
A. Reactive
If two accelerations of FHR (15 beats or
more) lasting for 15 seconds occur after
fetal movement
B. Non reactive
If no acceleration occurs with fetal
movement or no fetal movement
Biophysical Profile (BPP)
 Comprehensive assessment of five
biophysical variables:
1. fetal breathing movement
2. fetal movements of body or limbs
3. fetal tone (extension or flexion of
extremities)

4. 4. amniotic fluid volume (visualized as
pockets of fluids around the fetus)
5. reactive FHR with activity (reactive
NST)
 The first 4 variables are assessed by UTZ
scanning. FHR reactivity is assessed with
the NST.
 Determines the compromised fetus or
confirms the healthy fetus
(Criteria for BPP Scoring)
 A score of 2 is assigned to each normal
finding and 0 to each abnormal one, for a
maximum score of 10.
 Score of 8 (with normal amniotic fluid) and
10 are considered normal.
 Indication of BPP: (at risk of placental
insufficiency or fetal compromise because
of the following:
4. Intrauterine growth restriction (IUGR)
5. Maternal DM
6. Maternal heart disease
7. Maternal chronic HPN/ Preeclampsia/
eclampsia
8. Maternal sickle cell anemia
9. Suspected fetal post maturity
10. History of previous still births
11. Rh sensitization
12. Abnormal estriol excretion
13. Hypeethyroidism
14. Renal disease
15. Nonreactive NST
Chorionic Villi Sampling
 Involves obtaining a small sample of
chorionic villi from the developing placenta
 For 1st
trimester diagnosis of genetic,
metabolic, and DNA studies
 Can be performed either transabdominally
or transcervically
 Performed between 10 and 12 weeks; thus
it can not detect neural tube defect
 Risk of CVS include:
6. Failure to obtain tissue
7. Rupture of membranes
8. Leakage of amniotic fluid
9. Bleeding
10. Intrauterine infection
11. Maternal tissue contamination of the
specimen
12. Rh alloimmunization
13. Spontaneous abortion
II. Diagnosis
Wellness diagnosis
Knowledge Deficit
Altered Health Maintenance
Nutrition, less than required
III. Planning/ Implementation/ Evaluation
A. Nutrition – most important aspect
*Nutritional assessment is
based on
taking a diet history first:
1. food preferences/ eating
habits
2. cultural/religious
influences
3. occupation/educational
level
B. Prenatal Exercises
1. Tailor sitting
-stretches and strengthen perineal muscles;
increase circulation in the perineum; make
pelvic joints more pliable
2. Pelvic rock
-maintains good posture; relieves abdominal
pressure and low backache; strengthens
abdominal muscles following delivery
Component Normal (score= 2) Abnormal (score= 0)
Fetal breathing
movement
≥ 1 episode of
rhythmic breathing
lasting ≥ 30 seconds
within 30 minutes
≤ 30 seconds of
breathing in 30
minutes
Fetal
movements of
body or limbs
≥ 3 discrete body or
limb movements in
30 minutes (episodes
of active continuous
movement
considered as single
movement)
≤ 2 movements in 30
minutes
Fetal tone ≥ 1 episode of
extension of a fetal
extremity with return
to flexion, or opening
or closing of hand
No movements or
extension/flexion
Amniotic fluid
volume
≥ 2 accelerations of ≥
15 beats/min for ≥ 15
seconds in 20
minutes
0-1 acceleration in 20
minutes
Non stress Test Single vertical pocket
> 2 cm
Largest single vertical
pocket ≤ 2 cm

5. 3. Squatting
-stretches the pelvic floor muscle; should be
done15 minutes daily
4. Pelvic Floor Contraction (Kegel’s)
-promotes perineal healing; relieves
congestion and discomfort in pelvic region;
tones up pelvic floor muscles `
5. Abdominal Contractions
-strengthens abdominal muscle during
pregnancy and prevents constipation
in the postpartal period
Walking is the best exercise during
pregnancy
Jogging is questionable because of the
strain of extra weight of pregnancy placed
on the knees
C. Hygiene
If membranes rupture or vaginal bleeding is
present or during the last month of
pregnancy, tub baths are contraindicated.
D. Travel
Advise a woman who is taking a long trip by
automobile to plan for frequent rest or
stretch period
At least every 2 hours, she should get out of
the car and walk a short distance
Use of seat belt is advised (shoulder
harness and lap belts)
Infant car seat should be purchased
Traveling by plane is not contraindicated as
long as plane is pressurized. If more than 7
months, traveling by plane is not
recommended.
F. Immunization –Tetanus Toxoid
G. Nutritional Supplement
1. Folic acid
2. Iron
H. Managing Discomforts of Pregnancy
G. Clothing
Use of abdominal support such as light
maternity girdle for support not to compress
and constrict the abdomen
Avoid knee high stockings
H. Sexual Activity
Contraindicated:
1. Women with history of abortion
2. Rupture membrane
3. Vaginal spotting
I. Prenatal visit
Start of pregnancy – 32 weeks
Every month
On 32-36 weeks AOG
Every 2 weeks/twice a month
On 36 weeks AOG
Every week until labor pains set in

6. 3. Squatting
-stretches the pelvic floor muscle; should be
done15 minutes daily
4. Pelvic Floor Contraction (Kegel’s)
-promotes perineal healing; relieves
congestion and discomfort in pelvic region;
tones up pelvic floor muscles `
5. Abdominal Contractions
-strengthens abdominal muscle during
pregnancy and prevents constipation
in the postpartal period
Walking is the best exercise during
pregnancy
Jogging is questionable because of the
strain of extra weight of pregnancy placed
on the knees
C. Hygiene
If membranes rupture or vaginal bleeding is
present or during the last month of
pregnancy, tub baths are contraindicated.
D. Travel
Advise a woman who is taking a long trip by
automobile to plan for frequent rest or
stretch period
At least every 2 hours, she should get out of
the car and walk a short distance
Use of seat belt is advised (shoulder
harness and lap belts)
Infant car seat should be purchased
Traveling by plane is not contraindicated as
long as plane is pressurized. If more than 7
months, traveling by plane is not
recommended.
F. Immunization –Tetanus Toxoid
G. Nutritional Supplement
1. Folic acid
2. Iron
H. Managing Discomforts of Pregnancy
G. Clothing
Use of abdominal support such as light
maternity girdle for support not to compress
and constrict the abdomen
Avoid knee high stockings
H. Sexual Activity
Contraindicated:
1. Women with history of abortion
2. Rupture membrane
3. Vaginal spotting
I. Prenatal visit
Start of pregnancy – 32 weeks
Every month
On 32-36 weeks AOG
Every 2 weeks/twice a month
On 36 weeks AOG
Every week until labor pains set in