PRENATAL
MANAGEMENT
PRENATAL MANAGEMENT
FIRST VISIT: as soon as the mother missed a
menstrual period when pregnancy is suspected.
SCHEDULE OF VISITS
• Once a month up to first 32 weeks
• Twice a month (every 2 weeks) from 32 to 36
weeks
• Four times a month (every week) from 36 to 40
weeks
CONDUCT OF INITIAL VISIT
Baseline Data Collection
• To serve as basis for comparison with
information gathered on subsequent visits.
• To screen for high-risk factors.
• Medical and Surgical History – past
illnesses and surgical procedures, current
drugs used
• Family History to detect illnesses or
conditions that are transmittable
• Current Problems – activities of daily living,
discomforts, danger signs
Initial and Subsequent Visits
Vital Signs
• Temperature: slight rise because of increased progesterone and
increased activity of the thyroid gland; not to reach 38°C.
• CR: Plus 10 to 15BPM
• RR: May tend to be rapid and deep (16/min., deeper) because of
progesterone’s influence on the respiratory center. Maximum increase
under normal conditions: 24/min at rest.
• BP: Tends to be hypotensive with supine position: vena caval
syndrome.
• Prevention: LLR. BP lowest in the second trimester. Elevated BP
reading, may indicate pregnancy-induced hypertension (PIH).
Weight is checked in every visit.
• Total weight gain: 20 to 25 lb., with average of 24 Ib.; upper limit: 25 to
35 Ib.
• First trimester: 1 Ib. per month which is 3 to 4 Ib. total
• Second trimester: 0.9 to 1 Ib. per week or about 10 to 12 Ib.
• Third trimester: 0.5 to 1 Ib. per week or about 8 to 11 Ib.
• The patterns of the weight gain are more important than the amount of
weight gain.
• Normal weight gain patterns contribute to health of mother and fetus.
• Failure to gain weight is an ominous sign.
• Weight is therefore a measure of health of a pregnant mother.
Uterine testing for albumin and sugar
• Sugar – ideally not more than 1+
• Albumin – negative
Fetal growth and development assessment
• Fundal height
• Fetal heart tones/fetal heart rate
• Abdominal palpitation – Leopold’s maneuver
• Quickening – first fetal movement, plus subsequent
mobility
Obstetrical History
Preceding pregnancies and perinatal
outcomes:
4-Point System: Past pregnancies and
perinatal outcomes (F/TPAL)
• F – number of full term births
• P – number of premature births
• A – number of abortions
• L – number of currently living children
5-Point System: the total number of
pregnancies (G) is the first number
(G/TFPAL)
• G – total number of pregnancies
• F – number of full term births
• P – number of premature births
• A – number of abortions
• L – number of currently living children
Terms Related to Pregnancy Status
Estimates in Pregnancy
EDC/EDD: expected data of confinement/expected data of delivery.
Naegele’s Rule Formula:
• Add 7 days to the first day of the last menstrual period (LMP), subtract 3
calendar months then add 1 year
Given LMP: May 20, 2020
5 20 2020
- 3 + 7 + ___1
2 27 2021
EDD: February 27, 2021
Mittendorf’s Rule Formula:
• First, identify the LMP woman’s race (Caucasian/white or
non-Caucasian), and gravidity [primigravida (G1) or
multigravida (G2) above]
• Formula for Caucasian/white women, first time pregnant
(G1):
• EDD = [LMP + 15 days] – 3 months
• Formula for non-Cuacasian/non-white, multigravida:
• EDD = [LMP + 10 days] – 3 months
Date of Quickening
• Primigravida: Date of Q + 4 months and 20 days = EDC
• Multigravida: Date of Q + 5 months and 4 days = EDC
Fundic height.
• At symphysis pubis: 12 weeks
• At umbilicus: 20 to 22 weeks
• At xiphoid process: 36 weeks
Age of Gestation:
McDonald’s Rule (used in second and third trimesters)
First take the fundic height (FH) in centimeter using a tape measure.
Measure the distance from the top of the symphysis pubis over the
curve of the abdomen to the top of the uterine fundus using a tape
measure.
Formula for estimating age of gestation in lunar months:
FH x 2
7
Formula for estimating age of gestation in lunar weeks:
FH x 8
7
Batholomew’s Rule of Fours – measures
age of gestation by determining the position
of the fundus in the abdominal cavity.
EFW: estimated fetal weight
Johnson’s Rule: needs fundic height measure in
cm
• If unengaged:
EFW in g = [FH – 11] x 155
• If engaged:
EFW in g = [FH – 12] x 155
EFL: estimated fetal length in cm; Haase’s
Rule
First five months of pregnancy: square the month.
• To square the month is to multiply it by itself:
• Example: How long is a three-month old fetus?
3 x 3 = 9 cm
For the second half of pregnancy:
• Multiply month by 5.
• Example: How long is a 7-month-old fetus?
7 x 5 = 35 cm
