DR TECH and EINC YEAR 02

ST
SKILLS LAB – NCM 107 1 SEM – PRELIM

GYNECOLOGIC AND OBSTETRIC HISTORY

CARE AND MANAGEMENT OF  Gravidity is the total number of
ANTEPARTAL WOMAN pregnancy.
 Parity is the total number of delivered
Maternity nursing care considers meeting the need viable pregnancies; expressed as
of both, the mother and her unborn child (the fetus) number of term of pregnancies, preterm
plus her newly born child (the neonate). pregnancies.
 Viability the ability of the fetus to live
A healthy and safe mother means a healthy and outside in the uterus at the earliest
safe fetus/neonate. possible gestational age; 24 weeks or 5
– 6 months.
ANTEPARTUM PERIOD  GTPAL Score:
 It refers to the care given to the mother o G – Number of pregnancy
from fertilization to the beginning of o T – Term: Born between 37 – 42
contractions. weeks
o P – Preterm: Born more than 24
A. Personal Data; Civil status; religion, weeks but less than 37 weeks
occupation; education o A – Abortion: Number of pregnancy
B. Diagnosis of Pregnancy ending in therapeutic spontaneous
C. Baseline Data abortion
D. Contraceptive History and OB History o L – Living children
 General Rule in Getting GTPAL
PERSONAL DATA o Multiple gestation (twins, triplets)
 Name, Age, Address is counted as one (1) in the number
 Sex of pregnancy (gravida) and is
 Civil Status counted as one (1) in the number of
 Religion viable pregnancy (para).
 Occupation o If the product of conception was
 Education delivered before the age of viability
is considered under abortion.
DIAGNOSIS OF PREGNANCY o Stillbirth / IUFD is counted as one
 Fetal heart tones can be detected as
(1) viable pregnancy (para)
early as 8 weeks from the last
 If it falls between 37 to 42 weeks
menstrual period (LMP) by Doppler. The
it is counted under term
normal fetal heart rate is 120 – 160
pregnancy.
beats per minute as 8 days.
 If it falls less than 37 weeks but
 Fetal movements (“quickening”) are
more than 24 weeks it is counted
first felt by the primiparous mother at
in preterm pregnancy.
18 – 20 weeks.
 Primigravida – pregnant for first time
 Ultrasound will visualize a gestational
 Multigravida – pregnant more than
sac at 5 – 6 weeks and a fetal pole with
once
movement and cardiac activity by 7 – 8
 Nulliparous – never carried a
weeks. Ultrasound can estimate fetal
pregnancy to viability
age accurately if completed before 24
 Multiparous – has had two or more
weeks.
deliveries that were carried to viability.
 Estimated Date of Delivery. The
mean duration of pregnancy is 40
HISTORY
weeks from the LMP. Estimated Date of
 Medical and Surgical History and
Delivery (EDD) can be calculated by
prior hospitalizations are documented.
Naegele’s Rule.
 Medications and allergies are
recorded.
DR TECH and EINC YEAR 02
ST
SKILLS LAB – NCM 107 1 SEM – PRELIM

 Computed AOG is wrong

 Family History of medical illnesses,  Multiple Pregnancy
hereditary illness, or multiple gestation  Polyhydramnios (excessive
is sought. accumulation of amniotic fluid)
 Social History, cigarettes, alcohol, or  Molar Pregnancy
illicit drug use. B. FUNDIC HEIGHT IS TOO SMALL
 Review of systems. Abdominal pain,  Computed AOG is wrong
constipation, headaches, vaginal  Baby is not growing well
bleeding, dysuria or urinary frequency,
or hemorrhoids. ESTIMATING EXPECTED DATE OF
DELIVERY (EDD)
GENERAL PARENTERAL AND PHYSICAL PROCEDURE
ASSESSMENT  Determine the last normal menstrual
period.
TETANUS IMMUNIZATIONS  Consider the first day of the last
 It prevents maternal and neonatal menstrual period (LMP).
tetanus.  Consider the month in numerical term.
o TT1 – administered anytime during o For LMP of Jan to March:
pregnancy.  Add 9 to Months – Add 7 to days
o TT2 – administered 4 weeks after – present year
TT1; 3 year protection. Ex: LMP: Feb 10, 2019 ( 2 – 10-
o TT3 – administered 6 months after 2019)
TT2; 5 year protection. 2+9 = 11 (Nov)
o TT4 – administered 1 year after TT3; 10+7= 17 ( days)
10 year protection EDD: Nov. 17, 2019 (11-17-
o TT5 – administered 1 year after TT4; 19)
lifetime protection. o For LMP of April to December:
 Subtract 3 to Months – Add 7 to
ESTIMATION OF GESTATIONAL AGE days – Add 1 year
 Naegele’s Rule: Used to determine the Ex: LMP: Apr 15, 2019 (4-15-19)
expected date of delivery by 4-3 = 1 (Jan)
determining the LMP of the mother. 15+7 = 22 (days) + 1
 Mc Donald’s Rule: Used to determine year
the age of gestation. EDD: Jan 22, 2020 (1-22-20)
 Formula:
a. Length of fundus in cm X 8/7 = AOG FETAL LIE
in weeks.  It is the relationship of the long axis of
b. Length of fundus in cm X 2/7 = AOG the fetus to the long axis of the mother.
in months. a. Transverse
(horizontal/perpendicular)
HOW TO MEASURE THE FUNDIC HEIGHT  long axis of the fetus is at right
1. Patient in supine position angle to mother’s long axis
2. Bladder must be empty pathologic if present at term
3. Measure from the upper edge of the b. Longitudinal (vertical/parallel)
symphysis pubis to top of the fundus  long axis of the fetus is parallel
(do not push the fundus down) to mother’s long axis

 Cephalic presentation
POSSIBLE PROBLEMS WITH FUNDIC (head first)
HEIGHT  Breech presentation
A. FUNDIC HEIGHT IS TOO LARGE (buttocks first)
DR TECH and EINC YEAR 02
ST
SKILLS LAB – NCM 107 1 SEM – PRELIM

feet rest upon the anterior surface of

FETAL PRESENTING the legs. The arms are usually crossed
PART/PRESENTATION over the thorax and become parallel to
 The part of the fetal body that enters the sides and the umbilical cord lies in
the true pelvis and presents itself at the the spare between them of the lower
internal cervical os for delivery. extension. The relation of the fetal parts
to its own trunk; normal attitude of the
CEPHALIC PRESENTATION fetus is complete flexion.
 95% of term deliveries
 The fetal head is the presenting part STATION
maybe:  The relationship of the presenting parts
o Vertex Presentation of the fetus to the ischial spines of the
 The fetal chin is completely mother.
flexed upon the fetal chest or  Example:
thorax. o Degree of engagement measured in
 Occipital fontanel is the centimeters above or below the
presenting part. pelvic midplane from the presenting
o Sinciput Presentation part to the ischial spines.
 Moderately flexed.
 The anterior or large fontanel is POSITION
the presenting part.  Relationship of the fetal presenting
o Brow Presentation parts to specific quadrant of the
 The chin is partially extended. mother’s pelvis.
o Face Presentation o Vertex: Occiput, LOA, LOP, ROA.
 Hyper extended with chin ROP
presenting. o Fore: Chin (mentum), LMA, LMP,
RMA, RMP
BREECH PRESENTATION o Breech: Sacrum, LSA, LSP, RSA, RSP
 3% of term births
o Complete Breech LEOPOLD’S MANEUVER
 Feet and legs flexed on thighs;  A systematic method of observation and
buttocks and feet presenting palpation to determine the presenting
o Frank Breech part, fetal position, presentation and
 Legs extended on torso; feet up engagement. The women should be in
by shoulders buttocks presenting supine position with her knees flexed
o Footling slightly.
 Single (one foot)  MAIN OBJECTIVE
 Double (both feet) o Determine the presentation and
position of the fetus inside the
ATTITUDE uterus.
 Relationship of fetal parts to each  RATIONALE
other / fetus characteristics posture. o To assess the physical condition of
the pregnant client and the baby in
order to determine the nursing
needs of both.
 The fetus becomes folded or bent upon
itself in a such a manner that the back  PROCEDURE
becomes markedly convex, the head is 1. Explain the procedure to the
sharply flexed, the chin is almost client. (This is the initial nursing
contact with the chest, the thigh are actions in any procedure done for
flexed over the abdomen, the legs are the client)
bent at the knees and the arches of the
DR TECH and EINC YEAR 02
ST
SKILLS LAB – NCM 107 1 SEM – PRELIM

2. Instruct the client to empty the o Breech: hard firm and round and
bladder. The bladder lies anterior moves independently of the trunks.
the uterus. Palpating the abdomen
mean abdominal discomfort if the SECOND
bladder is full. Likewise, a full MANEUVER
bladder comes in the way of (Umbilical Grip)
palpating the lower abdomen, so, To
maneuvers 3 & 4 are not likely to determine/locate
yield desired results. the fetal back, face
3. Position client in dorsal the client and
recumbent. place the palm of
4. Drape client to provide privacy. each hand of
5. Warm two hands by rubbing one either side of the abdomen, gentle but deep
against the other briskly before pressure is exerted on a side if there is
placing them on the abdomen. resistant.
The case of warm hands during
palpation prevents tension and Structure is felt it is the fetal back on the
hardening of abdominal muscles other side, numerous small irregular parts
favoring good results. are felt it is ext. of the fetus.
6. Palpate gently.
7. To perform the first 3 THIRD
maneuvers, stand to either side MANEUVER
of the patient and face her. For (Pawlick’s Grip)
the 4th maneuver, reverse your This
position and face the patient’s maneuver
feet. determines
the part of the
MANAGEMENT & PROCEDURES fetus at the
LEOPOLD’S MANEUVER inlet of the
pelvis of the
FIRST MANEUVER mother.
(Fundal Grip)
Grasp the lower portion of the abdomen just
above the symphysis pubis between the
thumb and index finger and try to press the
thumb and finger together. If it is firm, it is
the head, on the other hand, if it is soft, it is
breech presentation.

FOURTH
While facing the woman MANEUVER
palpate the woman’s upper (Pelvic Grip)
abdomen with both hands. It determine
Assess size, shape, the fetal
movement and firmness of
part.

 Determine Presentation
o Cephalic: softer, symmetric has
attitude/posture and degrees of fetal
bony prominence and moves with
extremities is into the pelvis.
the trunk (buttock part)
DR TECH and EINC YEAR 02
ST
SKILLS LAB – NCM 107 1 SEM – PRELIM

The examiner faces the mother’ feet, and

with the tip of first three finger of each hand,
give deep pressure in the direction of the
axis of the pelvic inlet

MONITORING FETAL HEART TONES

FHT MONITORING
 MAIN OBJECTIVE
o To evaluate the condition of the
fetus and be warned of any fetal
distress; to diagnose multiple
pregnancy and to ascertain fetal
position.
 RATIONALE
o One way of assessing the status of
the fetus is by noting the
characteristics and rate of fetal heart
tones. Normally, the heartbeat of the
fetus ranges from 120-160 bpm.
 DETERMINATION OF FETAL HEART
TONE
o Every 30 min during beginning
labor
o Every 15 min. during active labor
o Every 5 min during second stage of
labor
o Normal fetal heart rate 120-160
beats/min
o The rate fluctuates slightly 5-15
beats/min when fetus moves/sleeps.
It can be increase/decrease.
 FETAL BRADYCARDIA
o FHR is below 120 beats/min for 10
min.
o A moderate bradycardia of 100 to
119 beats/min is not considered
serious probably due to compression
of fetal head during labor. Marked
decrease below 100 beats / min is a
possible sign of fetal hypoxia.
 FETAL TACHYCARDIA
o 160 beats/min and above for 10 min.
period. Moderate tachycardia 161-
180 bpm. Marked increase of 180
bpm may cause maternal hypoxia.