pre natal assessment

1. PRE- NATAL CARE
2ND TRIMESTER
ROSECHELLE SIUPAN-
ELARCO,RN,MAN

2. SCHEDULE OF CLINIC VISIT
 It should begin as soon as possible after the
first missed period.
 From first visit to 32 weeks: every 4 weeks
 From 32 to 36 weeks: every 2 weeks
 From 36 weeks until delivery: every week

3. Subsequent Clinic Visits
A. Maternal assessment
1. Blood pressure monitoring
2. Weight and edema assessment
3. Uterine changes
4. Urinalysis
5. Checking hemoglobin and hematocrit
levels.

4. Subsequent Clinic Visits
B. FETAL ASSESSMENT
 Fundic height measurement
 Fetal Heart Rate
 Fetal movements
 Leopold’s maneuver

5. C. Health Teachings
1.Normanl signs and symptoms of pregnancy
2.Minor discomfort and preventive management
3. Danger signs and symptoms
4. Nutrition and Diet
5. Rest, Exercise, and Relaxation
6. Avoidance of vices
7. Clothing
8. Sexual Relations
9. Travel
10. Preparation for baby’s birth, labor and delivery and
puerperium

6. MATERNAL ASSESSMENT
BP monitoring
 Expect a slight drop in the second trimester that returns to
normal on the third trimester.
 When taking BP remember it is highest when the woman is
sitting, intermediate at supine and lowest at left lateral
position
 ↑ in BP and wt. gain = HPN
 ↓ PR or RR may suggest bleeding

7. Weight measurement
 30 to 35 lbs 13-15 kgs(. during pregnancy ( Pilliteri)
 Underweight women (BMI of < 19.8 are advised to gain
a total 12.5-18 kg (28-40lbs)
 Normal weight(BMI of 19.8-26) 11.5-16kg(25-35lbs)
 Overweight (BMI 26-29) or obese limit to 7-11.5kg (15-
25lbs)
 22-35lbs
 1st tri wt gain is 2 to 4 lbs.
 2nd and 3rd tri 10 to 12lbs. per trimester

8. 3. Uterine changes
 Length- grows approximately 6.5 to 32 cm
 Depth- increases from 2.5 to 22 cm
 Width expands from 4 to 24 cm
 Weight inceases from 50 to 1000g
 Thickness- from 1cm to about 2cm ( by the
end pf pregnancy the wall thins to 0.5cm thick
 Volume of uterus increases from 2ml to more
than1000ml
 Can hold 7lbs (3175g)fetus plus 1000ml of AF=4000g

9. Hemoglobin and Hematocrit
levels
 To determine presence of anemia
 Hgb and Hct levels decreases (resulting to
pseudoanemia) caused by Iron deficiency or
Folic acid deficiency .
 Hemoglobin- 12 to 16mg/dl
 Hematocrit- 37 to47%

10. Assessment of Fetal Growth
and Development
Fundic height measurement/Estimating Fetal
Growth
McDonalds rule - is a method of determining the
growth of a fetus during mid pregnancy.
 Uterine height is measured from the top of the
symphysis pubis over the top of the fundus in
centimeters (cm).

12.  The distance from the fundus to the symphysis
pubis is equal to the week of gestation
between the 20th to 31st weeks of pregnancy
 Inaccurate in the third trimester because the
fetus is growing more in weight than in height
this time.

14. Assessing Fetal Well Being

15.  FHR should be 120-160
beats per minute
 Can be heard with a
Doppler : 10 – 12th
weeks of pregnancy ( 3
months)
 Fetoscope: 16 to 18th
weeks ( 4 months)
 Stethoscope: 20th
weeks
( 5 months)
FETAL HEART TONE/RATE

16.  Can be felt by the mother at 18 to 20 weeks(Quickening)
and peaks at 28 to 38 weeks.
 Fetal movements (FM) – a regular pattern of
10 movements in 20 min to 2 h twice is a good
indicator of fetal well-being; less than 10
movements in a 3-h period should be reported
Fetal Movement

17. FETAL MOVEMENT
 Sandovsky method – mother is in a left lateral
recumbent position after meal; fetus normally
moves a minimum of twice every 10 minutes or
an average of 10 -12x an hour
 Cardiff method – Count to ten
- records the time interval it takes for her to feel
10 fetal movements; usually within 60 minutes

18. By: ROSECHELLE B. SIUPAN,RN,MAN
LEOPOLDS MANEUVER

19.  systematic way to determine the position of a
fetus inside the woman's uterus.
 24 weeks gestation
Leopold's Maneuver

20. Things to remember
 Explain procedure to the patient.
 Ensure that the pregnant woman has recently emptied her
bladder.
 Drape properly to maintain privacy.
 Place woman in dorsal recumbent position, supine with knees
flexed to relax abdominal muscles. Place a small pillow under
the head for comfort.
 Warms hands prior to palpation rubbing together(Cold hands
can stimulate uterine contractions)
 Use the palm for palpation not the fingers.

21. The maneuvers are important:
 It helps to determine the position and
presentation of the fetus, which in conjunction
with correct assessment of the shape of the
maternal pelvis

23. First maneuver ( Fundal Grip)
 To determine fetal
part lying in the
fundus
 To determine fetal
presentation

24. First maneuver ( Fundal Grip)
 Stand at the side of
the bed facing the
client.
 Warm hands and
feels the upper
abdomen (fundus)
with tips of both
hands.

25. First maneuver ( Fundal Grip)
 Decide which pole of the fetus
is being held by observing
three points.
- Relative consistency: head is
harder and firmer
- Shape: head will be round
hard/smooth with transverse
groove of the neck
- Mobility: head will move
independently on the trunk
 Determine the fetal parts
palpated.

26. 1st Manuever
Findings:
Head is more firm,
hard and round that
moves
independently of
the body.
Breech is less well
defined that moves
only in conjunction
with the body.

27. Second maneuver ( Umbilical Grip)
 To identify location
of the fetal back
 To determine
position

28. Second maneuver ( Umbilical Grip)
 Still standing at the side of the
bed facing the client.
 Place the palm surfaces of both
hands on either side of the
abdomen
 First the right hand remains
steady on one side of the
abdomen while the left hand
explores the right side of the
woman's uterus .
By moving from top to the
lower segment of the
uterus to feel the fetal back
and the small fetal parts.
This is then repeated using
the opposite side and
hands.
Use gentle but deep pressure

29. 2nd Maneuver/Umbilical Grip
 Findings:
The lateral sides of the fundus
are palpated to determine the
position of the fetal back and
small parts.The fetal spine
will palpate as firm, flat and
linear. The fetal extremities
are palpable by their varying
contour and movements. The
purpose of this maneuver is
to determine whether the
fetal back is left or right.

30. LOCATING FETAL HEART SOUNDS BY FETAL
POSITION
FHT – heard best at the FETAL BACK

31. Third maneuver (Pawlick's Grip)
 To determine
engagement of
presenting part and
to estimate fetal
station
 To determine
presentation.

32. Third maneuver (Pawlick's Grip)
 Standing at the side of
the bed facing the client.
 Gently grasp the lower
portion of the abdomen
just above the symphysis
pubis, between the thumb
and the two fingers of
one hand and pressing
together.

33. 3rd Maneuver
 Findings:
The presenting part is
engaged if it is not
movable.
If it is not yet engaged it
is still movable
If it is firm, it must be
head
If it is soft, it could be
breech presentation.

34. Fourth Maneuver ( Pelvic Grip)
 To determine the
degree of flexion of
fetal head.
 To determine
attitude or habitus

35. Fourth Maneuver ( Pelvic Grip)
 The nurse/student
faces the client’s feet.
 The nurse/student
places the tips of her
three fingers at the
abdomen above the
inguinal ligaments then
presses her finger
downward and inward.

36. 4th Manuever
 Findings:
If cephalic prominences or
brow of the baby is on the
same side of the small fetal
parts, the head is flexed
If cephalic prominences is on
the same side of the fetal
back , the head is
extended.
Good attitude - if brow
correspond to the side (2nd
maneuver) that contained the
elbows and knees.
Poor attitude - if examining
fingers will meet an
obstruction on the same side
as fetal back (hyperextended
head)
Also palpates infant’s
anteroposterior position. If
brow is very easily palpated,
fetus is at posterior position
(occiput pointing towards
woman’s back)