CARE DURING

aNtepartum Period
Antepartum • Period of pregnancy or
period before labor and
Period delivery

• medical and nursing care given

Antepartum to the pregnant woman
care between conception and the
onset of labor.

• A healthy mother and a

Goal of healthy fetus through
identification of risk factors,
prenatal care assessment for complications,
and education of the mother.
 PURPOSES OF PRENATAL CARE
1. Promotion and maintenance of maternal health

2. Supervision of pregnancy and fetal development

3. Early detection and prompt management of high

risk conditions
4. Preparations of woman and her family for the tasks
of labor and puerperium

5. Assure the overall fetal and maternal well being

6. Provide time for education about pregnancy,

lactation and newborn care.
 SCHEDULE OF PRENATAL VISITS
Subsequent visit for
Subsequent visit for
First Visit: Normal Pregnancy
High Risk Pregnancy
conditions

Done as soon as First 32 weeks: Every 2 weeks up

the woman to 30 weeks AOG
misses a Once a month
menstrual period
and pregnancy is 32-36 weeks: Every week
suspected from 30 to 36
Twice a month weeks AOG

Twice a week -
36-40 weeks:
from 37 weeks up
Every week to delivery
 Components
Of
Prenatal Visit
 A. Initial • Establishing rapport
Interview/ • Gaining information about a woman’s
History taking physical and psychosocial health

• name, age, address, telephone

number, religion, and health insurance
information, occupation and
B. Demographic
Data educational level, marital/relationship
status and contact person
information.
 • Reason for consult
C. Chief • Last Menstrual Period(LMP)
• Signs of early pregnancy,
Concern discomforts(e.g. nausea, vomiting,
breast changes, or fatigue)
 • Support people
• Sexual partner, marital status, Source and
D. Family level of income
Profile • History of family illnesses (cardiovascular,
renal disease, blood disorders, genetically
and inherited diseases or congenital anomalies
Medical • Whether the pregnant woman live alone or
History not
• Source of emotional support, advice or help
with problems
 • Childhood diseases
• Allergies, drug sensitivities
E. History • Sexually transmitted infections
• Diabetes, thyroid disease, asthma,TB, Kidney,
of Past heart diseases, UTI, etc.
Illnesses • Immunizations
• Gynecologic disorders(myomas.cysts,polyps)
• Any past surgical procedures
 • completes the subjective
information.
• helps women recall concerns
F. Review Of they forgot to mention
Systems • Use a systematic approach, such
as head to toe, asking about body
parts or systems and any diseases
that the woman may have had
 REVIEW OF SYSTEMS
Body Parts Questions to Ask
Head Headache? Head injury? Seizures? Dizziness? Fainting?
Eyes Vision? Glasses needed? Diplopia or double vision? Infection?
Glaucoma? Cataract? Pain? Recent changes?
Ears Infection? Discharge? Earache? Hearing loss? Tinnitus? Vertigo?
Nose Epistaxis (nose bleeds)? Discharge? How many colds a year?
Allergies? Postnasal drainage? Sinus pain?
Mouth and Dentures? Condition of teeth? Toothaches? Any bleeding of
pharynx gums? Hoarseness? Difficulty in swallowing? Tonsillectomy?
Last dental exam?
Neck Neck: Stiffness? Masses?
Breasts Lumps? Secretion? Pain? Tenderness?
 REVIEW OF SYSTEMS
Body Parts Questions to Ask
Respiratory system Cough? Wheezing? Asthma? Shortness of breath? Pain? Serious chest
illness, such as tuberculosis or pneumonia?
Cardiovascular system History of heart murmur? History of heart disease such as rheumatic fever?
Hypertension? Any pain? Palpitations? Anemia? Does she know her blood
pressure? Has she ever had a blood transfusion?

Gastrointestinal system What was her prepregnancy weight? Vomiting? Diarrhea? Constipation?
Change in bowel habits? Rectal pruritus? Hemorrhoids? Pain? Ulcer?
Gallbladder disease? Hepatitis? Appendicitis?
Genitourinary system Urinary tract infection? Hematuria? Frequent urination? Sexually
transmitted infection? Pelvic inflammatory disease? Hepatitis B? HIV? Was
subfertility a concern? Did she have a problem getting pregnant?
Extremities Varicose veins? Pain or stiffness of joints? Any fractures or dislocations?
Skin Any rashes? Acne? Psoriasis?
 • menarche
• Usual cycle length & regularity of menses
• interval between periods
• amount of menstrual flow
• Menstrual problem and discomforts
G. Gynecologic
experienced(e.g. Dysmenorrhea)
History • past gynecologic/reproductive surgery(e.g tubal
surgeries after ectopic pregnancy due to tubal
scarring,uterine surgery,CS
• reproductive planning methods(e.g. IUD, oral
contraceptive)
 • Previous pregnancies, type and outcome
of birth
• history of previous miscarriage or abortion
• Sexual history method of contraception
H. Obstetrics used
History • History of present pregnancy & LMP
• Preceding pregnancies and perinatal
outcomes
• Determine OB score(pregnancy status)
 Obstetrics History

GPTPAL or GPTPALM
• A more comprehensive system for classifying
pregnancy status
• provides greater detail a woman’s pregnancy
history.
G= Gravidity
• number of times a woman has been pregnant,
irrespective of the outcome

P= Parity
• number of pregnancies that reach 24 or more weeks
resulting in viable fetus whether born dead or alive.
(note: twins, triplets etc. considered as one).
P or Parity is broken into TPALM
• number of full term infants ( born at 37
T =Term weeks onward)
• number of preterm infants ( born before 37 weeks
P = Preterm but more than 24 weeks(age of viability)
• number of abortions/spontaneous miscarriages or
A = Abortions therapeutic abortions < 24 weeks or age of viability
or weighs < 500g
• Number of presently living
L = Living children,twin,triplets are count individually

M =Multiple gestation • Twins, triplets, quadruplets

• Mrs. R. 2 mons AOG visited the RHU w/ an OB hx
that reveals first pregnancy resulted to an abortion.
G P T P A L M
1 abortion 1 0 0 0 1 0 0
1-2ND mon 1 0 0 0 0 0 0
•Total 2 0 0 0 1 0 0

Therefore
Mrs. R’s OB
score:
2000100
and she is
multigravida
nullipara.
 Sample Problem for GPTPALM
A pregnant woman who had the following past history- a
boy born at 40 weeks gestation, now alive and well; a girl
born at 38 weeks gestation,now alive and well; a girl
born at 32 weeks gestation, now alive
OB Scoring will be summarized as follows:
❖If asked about Gravidity and Parity = G4,P3
❖If asked about Overall OB score = 4- 3 -2-1-3-0
A pregnant woman who had the following past history- a
boy born at 40 weeks gestation, now alive and well; a girl
born at 38 weeks gestation, born dead; a girl born at 32
weeks gestation, now alive and. She also delivered at 13
weeks .The last pregnancy was triplets at 36 weeks but all
are living.
OB Scoring will be summarized as follows:
❖If asked about Gravidity and Parity = G6,P4
❖If asked about Overall OB score = 6- 4-2-1-1-5-1
 Classroom Activity: Compute OB Score
Mrs. E. is pregnant for the fifth time on her 2 mons AOG
.She underwent two elective abortions in the first
trimester on her 1st and 2nd pregnancies . She has a son
who was born at 40 weeks gestation, well and alive on
her 3rd pregnancy and daughter who was born at 36
week of her 4th pregnancy, well and alive:
 G P T P A L M

•Total

Therefore
Mrs. E’s OB
score:
I. Baseline Height/Weight

J. Vital Sign measurement

K. Measurement of Fundal
Height, Leopold’s
Maneuver
L. Physical Assessment
and Examination
M. Vaginal Examination

N. Evaluation of fetal well

being, Fetal heart sounds
O. Health teachings and
Prenatal education(Nutrition,
Immunization, Exercise,
Identifying Risk pregnancy)
Summary of Assessment for the First Pregnancy Visit
 Procedures can be done during
Antenatal Visit

• Measurement of Fundal Height

• Leopold’s Maneuver
• Auscultation of Fetal Heartbeat
 Measurement of fundal height:

https://www.google.com/search?q=steps+in+measur
ing+fundal+height&rlz=1C1VDKB_enPH969PH969&o
q=&gs_lcrp=EgZjaHJvbWUqCQgAECMYJxjqAjIJCAA
 Fetal Growth - Fundal Height Measurements

1. Mother semi-recumbent, with bladder empty.

• Explain the procedure to the mother and gain verbal

consent
• Wash hands
• Have a non-elastic tape measure to hand
• Ensure the mother is comfortable in a semi-recumbent
position, with an empty bladder
• Expose enough of the abdomen to allow a thorough
examination
 2. Palpate to determine fundus with two hands.
• Ensure the abdomen is soft (not contracting)
• Perform abdominal palpation to enable accurate identification of the uterine fundus.

3. Secure tape with hand at top of fundus.

• Use •the tape measure with the centimetres on the underside to
reduce bias
 4. Measure to top of symphysis pubis.

• Measure from the top of the fundus to the top of

the symphysis pubis
• The tape measure should stay in contact with the
skin

5. Measure along longitudinal axis of uterus, note metric measurement.

Measure along the longitudinal axis without correcting to the abdominal midline
•

Measure only once

 6. Plot on customised chart, record in notes

• Record the metric measurement and plot it on the growth chart.

 Leopold’s Maneuver
• Please watch he video:

• https://www.youtube.com/watch?v=B1z31tNWmok
Auscultation: Fetal Heart Tone
FHB: 120-160bpm