OBSTETRICAL ASSESSMENT : short notes for nurses

OBSTETRICAL ASSESSMENT

Share this on facebook

GESTATION

  • Time from fertilization of ovum until the estimated date of delivery or confinement
  • It is about 280 days
  • Nagele’s rule : for estimating date of confinment , add 7 days to the first day of the last menstrual period substract 3 months and then add 1 year to that date ; alternatively add 7 days to the date of the last menstrual period and count forward 9 months

GRAVIDITY AND PARITY AND USE OF GPTPAL

    • G is Gravidity refers to number of pregnancies
    • P is Parity is the number of births ,not the number of fetuses
    • T is Term births, the number born at term
    • P is preterm births
    • A is Abortions and or miscarriages
    • L is the number of current living children




PREGNANCY SIGNS

A) Presumptive signs
  • Amenorrhea, nausea and vomitting
  • Pronounced nipples, increased size and feeling of fullness in breasts
  • Quickening : first perception of fetal movement may occur as early as the 16 – 20th week of gestation
B) Uterine signs : Seen in first trimester
  • Piskcek’s sign: assymetrical enlargement of uterus if there is lateral implantation
  • Hegar’s sign: upper part of body of uterus is enlarged, lower part is empty and cervix is firm
  • Palmer’s sign: regular and rhythmic uterine contraction at 4-8 weeks
Other signs
  • Jacquimier’s sign\Chadwick’s sign: bluish discolouration of vagina occurs at 6 weeks
  • Osiander’s sign \vaginal sign: increased pulsation felt in the lateral fornices at 8 th week
  • Goodell’s sign \cervical sign : softening of cervix
  • Ballottement: rebounding of the fetus against the examiner’s fingers on palpation
  • Braxton Hicks contractions
C) Positive signs(diagnostic)
  • FHR detected by electronic device at 10 – 12 weeks and by fetoscope at 20 weeks of gestation
  • Active fetal movements palpable by examiner

FUNDAL HEIGHT

    • Measured to evaluate the gestational age of the fetus
    • During 2nd and 3 rd trimester fundal height in centimeters approximately equals fetal age in weeks +  2cm
    • At 16 weeks fundus is in half way between symphysis pubis and umbulicus
    • At 20 – 22 weeks fundus is approximately at the location of umbulicus
    • At 36 weeks fundus is at the xiphoid process




MATERNAL RISK FACTORS

A) German measles (Rubella)
  • Maternal infection during the first 8 weeks of gestation carries the highest rate of fetal infection
  • Do not become pregnant for 1 -3 months after rubella immunization
  • If rubella vaccine is administered at the same time as Rh0(D) immunoglobulin,it may not be effective
  • Breast feeding can continue after rubella vaccine
  • Rubella vaccine is administered postpartum via subcutaneous route if the titre is < 1:8 (negative titre). Inquire about sensitivity to eggs

Sexually transmitted infections like HIV,viral hepatitis .

Substance abuse like alcoholism.

Adolescent pregnancy

Leave a Reply

Your email address will not be published. Required fields are marked *