Prenatal Assessment 1 Three trimesters 3 3 month periods a 9 calendar months or 10 lunar months subdivided into 3 month intervals trimesters significant issues as the woman deals with physiologic and psychologic changes nine months of pregnancies and with the changes one of the goals is women in prenatal care early 2 Physiologic and Psychologic changes 3 Goals women in prenatal care early a See a practitioner confirm deny symptoms dealt with information health education physical well being weight gain sexual activity staying healthy and fit nutrition If pregnant given information and support they need to begin the process of a healthy pregnancy Told about how to exercise if working Goal compliant with this care so the outcome is a healthy delivery at term for mother and babe 4 Outcome healthy delivery for mother and baby 5 Late prenatal care problems with pregnancy pre term labor pregnancy induced hypertension no screening for risk factors Difficulties with pregnancy can t screen for risk factors that women comes to pregnancy with 6 Comprehensive health history gather info about health hx how does she feel emotional parameters does she have support The first time she comes want to know about her history who knows about pregnancy how do they feel then have a plan throughout pregnancy After we speak with her and gather health hx we want to determine if the pregnancy is confirmed and if so how far along is the pregnancy 7 How many weeks gestation first day of last menstrual period used to calculate EDB estimated date of birth Look for first day of last menstrual period 8 Naegle s Rule 3 7 see handout a EDC estimated date of confinement medical term i Do you have fetal heart tones fetal movement Is the pregnancy growing proportionately Naegle s rule calculation of due date In medical terms EDC will be a great deal in prenatal records EDC estimated date of confinement medical term currently in all prenatal records and what we do on each subsequent prenatal visit we compare the EDC with how large the uterus is whether hearing fetal hert tones movement b EDD estimated date of delivery nursing term c EDB estimated date of birth nursing term these all mean the same thing d LMP first day of last menstrual period to calculate this find first day of last menstrual period preterm or at term didn t know they were pregnant that happens so we ask that information if she doesn t remember the date we ask for current events was is in the spring weekend what else was going on to try to get close to this date some patients will know the exact LMP but they will tell you exactly when they conceived which was a little bit later than their LMP those who are getting hormones to help ovulate will have it downed to a refined science they can tell you exactly how many days they are pregnant we would confirm with an ultrasound i If can t remember date current events what else was going on ii Fertility issues they usually know exactly iii LMP 3 months 7 days 1 April 15 4 15 3 7 1 22 January 22 not a finite day 2 used to determine number of weeks pregnant 3 ultrasound used as well discussed at a later date a can see what s going on with the baby i fetal well being placenta Amniotic fluid breathing movements fetal movements everything they do on the outside they do on the inside except breathe and have a bowel movement suck thumbs open eyes hiccups twirl arms urinate to help change amniotic fluid every 72 hours in pregnancy through the placenta cord to baby on a journey to confirm week by week at end of pregnancy all along the way confirming fetal is well and is growing appropriately for the date that is predicted if that s incongruent we will do further testing it could be her date was wrong could have been spotting that she thought was a period or not compare with physical finding last confirmation finding is to do an ultrasound many strategies and info we gain from ultrasound that tells us about fetal well being and can actually see the fetal breathing movements etc a fetus in utero is going to do everything they will do after they are born except breathe air and have a bowel movement they stretch their arms they have startle responses they urinate they are part of the plumbing amniotic fluid changes every 72 hours so baby doesn t stay in the same stagnant fluid gradually interchanged through the circulation swallows etc amniotic fluid stays fresh ultrasound gives us that information e Obstetric history Going to have a form that will give us the info about her pregnancies go to form f G P A see other handout g Health History Summary i General history 1 Write notes in a section about risks Some section will ask for general medical hx whether the patient has it or if the family has it Preventing Risk Guide an adolescent over 35 yo hx of multiple spontaneous abortion previously had PID does she smoke does she use substances abuse hx of loss of pregnancy When was her last menstrual period lmp based on that calculate EDC EDD EDB ii General obstetric history about 1 year 1 Are the pregnancies close together need a year to heal usually need 2 Weights of the babies weight gradually larger that means those pregnancies were at risk for babies being LGA raises risk for fetus and mother in delivery 3 C sections or vaginal deliveries 4 Complications 5 Problems since conception a Headaches if not relieved by normal analgesic could mean at risk for PID or does she have hx of migranes b N V most patients may have morning sickness most don t have excessive vomiting if in 2nd trimester and having excessive n v she might have hyper emesis gravidara puts mother and fetus at risk baby not gaining weight losing fluid and electrolytes Any vaginal bleeding could mean miscarriage ask about medications substances cigarettes OTC drugs for sleep allergies cough medicine iii General health iv Complete physical 1 Speculum exam the patient is prepared and given support and a speculum is inserted gradually and expanded to look at vaginal wall and cervix done before bimanual exam the opening to cervix looks like a little slit first pregnancy one or two cervix a little bit wider and slit a little bit longer if any scar tissue or marking they would note it if abnormal pap smear and had to get some cells removed that would be noted 2 Bimanual pelvic exam Pelvic exam that will be done and note any changes in cervix HCP will palpate with a bimanual exam one gloved hand in vagina one pressing on abdomen to determine height size of fundus