Ateprenatal medical termenology

1. Antepartal Nursing Assessment
CHAP.9

2.  Antepartum : time between conception and the onset of labor ; prenatal
 Intrapartum : time from the onset of true labor until the birth of the baby and
placenta
 Postpartum : time from the delivery of the placenta and membranes until the
woman’s body returns to a nonpregnant condition; typically about 6 weeks
 Gestation : the number of weeks of pregnancy since the first day of the last
menstrual period
 Abortion : birth that occurs before the end of 20 weeks’ gestation or the birth
of a fetus-newborn who weighs less than 500 g
 Stillbirth : a baby born dead after 20 weeks’ gestation
 Term : normal duration of pregnancy
 Full term : births occurring between 39 weeks 0 days and 40 weeks 6 days
 Postterm : births occurring after 42

3.  Preterm labor : labor that occurs after 20 weeks’ gestation but before completion of 36
weeks’ gestation
 Postterm labor : labor that occurs after 42 weeks’ gestation
 Gravida : any pregnancy, regardless of duration, including present pregnancy. abbreviated
as G.
 Nulligravida : a woman who has never been pregnant
 Primigravida : a woman who is pregnant for the first time
 Multigravida : a woman who is in her second or any subsequent pregnancy
 Para : birth after 20 weeks’ gestation regardless of whether the baby is born alive or dead.
abbreviated as P.
 Nullipara : a woman who has had no births at more than 20 weeks’ gestation
 Primipara : a woman who has had one birth at more than 20 weeks’ gestation regardless
of whether the baby was born alive or dead

4. • Multipara : a woman who has had two or more births at more than 20 weeks’
gestation
• TPAL
• T: number of early, full, or late term births the woman has experienced
(number of babies born at the 37 weeks’ gestation)
• P: number of preterm births (births after 20 weeks’ gestation but before 37
weeks’ gestation, whether living or stillborn)
• A: number of pregnancies ending in either spontaneous or therapeutic abortion
(before 20 weeks’ gestation)
• L: number of currently living children to whom the woman has given birth
‫المرأة‬ ‫أنجبتهم‬ ‫الذين‬ ‫األحياء‬ ‫األطفال‬ ‫عدد‬

5. Prenatal History
• Details of current pregnancy
– First day of last normal menstrual period (LMP) (Is she sure of the dates or
uncertain? Do her cycles normally occur every 28 days, or do her cycles tend
to be longer?)
– Presence of cramping, bleeding, or spotting since LMP
– Woman’s opinion about the time when conception occurred and when baby
is due
– Woman’s attitude toward pregnancy (Is this pregnancy planned? Wanted?)
– Results of pregnancy tests, if completed Any discomforts since LMP such as
nausea, vomiting, urinary frequency, fatigue, or breast tenderness

6. Prenatal History
• History of past pregnancies
– Number of pregnancies
– Number of abortions, spontaneous or induced Number of living children History of
previous pregnancies, length of pregnancy, labor and birth, type of birth (vaginal, or
cesarean), location of birth, type of anesthesia used woman’s perception of the
experience,
– Neonatal status of previous children: Apgar scores, birth weights, general
development, complications, and feeding patterns (breast milk, formula, or both). If
breastfed, for how long?
– Loss of a child (miscarriage, elective or medically indicated abortion, stillbirth,
neonatal death). Cause of loss
– Blood type and Rh factor
– Prenatal education classes and resources

7. Prenatal History
• Gynecologic history
– Date of last (Pap) smear; result?
– Previous infections: vaginal, cervical, pelvic inflammatory disease (PID), or sexually
transmitted infections (STIs)
– Previous surgery (uterine, ovarian) Age at menarche Regularity, frequency, and
duration of menstrual flow
– History of dysmenorrhea
– History of infertility
– Contraceptive history
– Any issues related to infertility or fertility treatments

8. • Current medical history
• Weight ,height, body mass index (BMI)
• General health, including nutrition (dietary practices such as vegetarianism; lactose
intolerance; food allergies?)
• regular exercise program (type, frequency, and duration)
• monthly breast self-examination; eye examination;
• date of last dental examination
• medications presently being taken
• Previous or present use of alcohol, tobacco, or caffeine
• Illicit drug use or abuse ‫مشروعة‬ ‫غير‬ ‫بصورة‬ ‫تعاطيها‬ ‫أو‬ ‫المخدرات‬ ‫تعاطي‬
• Drug allergies and other allergies (
• Potential teratogenic insults to this pregnancy ( viral infections, medications, x-ray ,surgery,
or cats )
• Presence of chronic disease
• illnesses since LMP (flu, measles) Record of immunizations (especially rubella); up to

9. • Past medical history
• Childhood diseases
• Past treatment ,Any hospitalizations? Major injuries?)
• Surgical procedures
• Presence of bleeding disorders or tendencies (Has she received blood transfusions? Will
she accept blood transfusions?)
• Family medical history
• Presence of diabetes, cardiovascular disease, cancer, hypertension,
• Occurrence of multiple births
• History of congenital diseases or deformities
• Occurrence of cesarean births and cause, if known

10. • Genetic history
• Birth defects
• Recurrent pregnancy loss
• Stillbirth Down syndrome, ،
• Genetic disorders (cystic fibrosis, sickle cell disease/trait, muscular dystrophy).
• Religious, spiritual, and cultural history
• Does the woman wish to specify a religious preference on her medical record?
• Does she have any spiritual beliefs or practices that might influence her health care or
that of her child e.g receiving blood products, dietary considerations, or circumcision
rites?
•
‫مشتق‬ ‫تلقي‬ ‫مثل‬ ‫طفلها‬ ‫رعاية‬ ‫أو‬ ‫الصحية‬ ‫رعايتها‬ ‫على‬ ‫تؤثر‬ ‫قد‬ ‫روحية‬ ‫ممارسات‬ ‫أو‬ ‫معتقدات‬ ‫أي‬ ‫لديها‬ ‫هل‬
‫أو‬ ‫الدم‬ ‫ات‬
‫الختان؟‬ ‫طقوس‬ ‫أو‬ ‫الغذائية‬ ‫االعتبارات‬

11. • Current medical history
– Presence of disease conditions such as diabetes
– Immunizations (especially rubella)
– Presence of any abnormal symptoms
– Occupational history
– Occupation Physical demands e.g Does she stand all day
– Exposure to chemicals or other harmful substances
– Opportunity for regular meals and breaks for nutritious snacks
– Provision for maternity or family leave ‫توفير‬
‫األسرة‬ ‫أو‬ ‫األمومة‬ ‫إجازة‬

12. – Father’s history
– Age
– Significant health problems
– Blood type and Rh factor
– Presence of genetic conditions or diseases in him or in his family history
– Occupation
– Educational level
– Current tobacco use, drug use, and alcohol intake
– Thoughts/feelings about the pregnancy

13. • Personal history
• Age
• Educational level
• Housing; stability of living conditions; neighborhood safety; animals in the home
‫المنزل‬ ‫في‬ ‫الحيوانات‬ ‫الحي‬ ‫سالمة‬ ‫؛‬ ‫المعيشية‬ ‫الظروف‬ ‫استقرار‬ ‫؛‬ ‫إسكان‬
• Economic level
• Any history of emotional or physical deprivation‫حرمان‬ or abuse of herself or children
• History of emotional/mental health problems e.g depression in general, postpartum
depression, anxiety
• Support systems
• Personal favorites about the birth
• Feeding preference for the baby (Breast milk or formula?)

14. Prenatal Risk-Factor Screening ‫قبل‬ ‫الخطر‬ ‫عوامل‬ ‫فحص‬
‫الوالدة‬
Risk factors are any findings that suggest a negative outcome for either the woman or her
unborn child.
Screening for risk factors is an important part of the prenatal assessment. Many risk factors
can be identified during the initial assessment or during subsequent visits
Any pregnancy may begin as low risk and change to high risk because of complications
Table 9–1 Prenatal High-Risk Factors/ important page 550

15. Initial Prenatal Assessment
 Consider physical, cultural, and psychosocial factors that influence her health.
 Establish nurse-client relationship
 Discuss religious or spiritual, cultural, or socioeconomic factors
 History
 prepare the woman for the physical examination(vital signs; woman’s body, pelvic
examination).
 Ask woman to provide a clean urine specimen before the examination- empty bladder is
more comfortable‫ا‬
 Assessment Guide: Initial Prenatal Assessment / important.

16. Determination of Due Date
• “due date,” or the date around which childbirth
• estimated date of birth (EDB)
• Nägele’s rule
• may be accurate determiner of the EDB if the woman has a history of menses every 28 days,
remembers her LMP, and was not taking oral contraceptives before becoming pregnant
• ovulation occurs 14 days before the onset of the next menses, not 14 days after the previous
menses
– Begin with the first day of the LMP ‫الدورة‬ ‫من‬ ‫األول‬ ‫باليوم‬ ‫ابدأ‬
– Subtract 3 months OR add 9 month , and add 7 days

17. First day of LMP November 21
Subtract 3 months − 3 months
August 21
Add 7 days + 7 days
EDB (of the next year) August 28
It is simpler to change the months to numeric terms:
November 21 becomes 11–21
Subtract 3 months −3 months
8–21
Add 7 days + 7 days
EDB (of the next year) 8–28

18. • Uterine Assessment /Physical Examination – -
Fundal height: Measurement of uterine size
 Distance in centimeters from the top of the symphysis pubis to the top of the
uterine fundus
 Fundal height in centimeters correlates well with weeks of gestation between
22 and 34 weeks
 If woman is very tall or very short, fundal height will differ
 Should be measured by the same examiner each time
 Woman should have voided, same position each time
 Third trimester, variations in fetal weight decrease the accuracy of FH

19. Assessment of Fetal Development
Quickening: Fetal movements felt by the mother, called quickening, may indicate that the fetus is nearing
20 weeks’ gestation
• may be experienced between 16 and 22 weeks’ gestation
Fetal Heartbeat: :
 ultrasonic Doppler device: fetal heartbeat at 8 to 12 weeks’ gestation
 110 to 160 beats/min.
Ultrasound:
 early pregnancy: Transvaginal ultrasound ،
 after about 10 weeks, transabdominal ultrasound Method used to measure fetal parts
 a gestational sac as early as 5 weeks after the LMP,
 fetal heart activity by 6 to 7 weeks, ،
 fetal breathing movements by 10 to 11 weeks of pregnancy.

20. EDB Wheel

21. Fetal Position When McDonald’s Method Used

23. ssessment of Pelvic Adequacy (Clinical Pelvimetry)
• The pelvis can be assessed vaginally to determine whether its size is adequate for a vaginal birth
Pelvic inlet ‫مدخل‬
‫الحوض‬
• Diagonal conjugate (the distance from the lower posterior border of the symphysis pubis to the
sacral promontory): at least 11.5 cm
• Obstetric conjugate (a measurement approximately 1.5 cm (0.60 in.) smaller than the diagonal
conjugate): 10.0 cm (3.9 in.) or more
Pelvic outlet
• Anteroposterior diameter: 9.5 to 11.5 cm (3.75 to 4.5 in.)
• Transverse diameter (bi-ischial or intertuberous diameter): 8 to 10 cm (3.15 to 3.9 in.)

24. Basic Screening Tests:
• Pap smear
• U/A
• Complete blood count
• Rubella titer
• ABO and Rh typing
• Hepatitis B screen
• Syphilis and gonorrhea screening

25. Other Tests:
• Drug screen
• HIV testing
• Sickle cell screen
• Cystic fibrosis screen
• Screen for chromosomal anomolies and neural tube defects
• 1-hr 50g GTT at 24-28 weeks
• Group B strep test at 35 to 37 weeks

26. Subsequent Client History
• Adjustment of the support person and of other children
• family Preparations: the family has made for the new baby
• Discomfort, kinds of discomfort
• Physical changes that relate directly to the pregnancy, such as fetal movement
• Exposure to contagious illnesses
• Medical treatments and therapies prescribed for nonpregnancy problems since the last
visit
• Consumption of prescription or over-the-counter medications or herbal supplements
• Use of complementary and alternative therapies
• Danger signs of pregnancy

27. Danger Signs of Pregnancy
‫الحمل‬ ‫على‬ ‫الخطر‬ ‫عالمات‬

28. Subsequent Prenatal Assessment
The recommended frequency of antepartum visits in an uncomplicated pregnancy
is as follows
• Every 4 weeks for the first 28 weeks’ gestation
• Every 2 weeks from 28 weeks’ until 36 weeks’ gestation
• After week 36, every week until childbirth For psychological problems, provide
ongoing support and counseling

29. Subsequent Prenatal Assessment
• Assessments during prenatal visits.
– Vital signs and weight
– Edema
– Uterine size and fetal heartbeat
– Urinalysis
– Blood tests for AFP, glucose
– Vaginal swab for group B strep
– Expected psychological stage of pregnancy.
– Assessment Guide Subsequent Prenatal Assessment

30. Assessment Guide Subsequent Prenatal Assessment/ important
Normal Physiologic Changes
• Pulse may increase by 10 beats per minute
• Respiration may be increased and thoracic breathing predominant
• Temperature and blood pressure within normal limits

31. Normal Physiologic Changes
• Weight varies: Should be proportional to the gestational age of the fetus
• Nose: Nasal stuffiness
• Chest and lungs: Transverse diameter greater than anterior-posterior diameter
• Skin:
– Linea nigra
– Striae gravidarum
– Spider nevi
• Mouth: Gingival hypertrophy
• Neck: Slight hyperplasia of thyroid in the third trimester – small, nontender nodes

32. Normal Physiologic Changes
• Breasts
– Increasing size
– Pigmentation of nipples and areola
– Colostrum appears in third trimester
• Abdomen
– Progressive enlargement
– Fetal heart rate heard at approximately 12 weeks’ gestation
• Extremities: Possible edema late in pregnancy
• Spine: Lumbar spinal curve may be accentuated

33. Normal Physiologic Changes
• Pelvic area: Vagina without significant discharge
• Cervix closed
• Uterus shows progressive growth
• Laboratory tests
– Physiologic anemia may occur (decrease in hemoglobin and hematocrit)
– Small degree of glycosuria may occur