Prenatal Care

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 Diagnosis of Pregnancy
• Signs and Symptoms • Signs and Symptoms
– Cessation of Menses – Changes in cervical
– Breast Changes mucosa
– Skin Changes – Changes in vaginal mucosa
– Perception of Fetal → Chadwick sign
Movements – Cervical changes
– Pregnancy test :
measurement of hCG
– Sonographic recognition
 Initial Prenatal Evaluation
The major goals are to:
1. Define the health status of the mother and
fetus
2. Estimate the gestational age
3. Initiate a plan for continuing obstetrical care
*Williams Obstetrics 23rd edition
 Definitions
• Nulligravida: a woman who currently is not pregnant, nor
has she ever been pregnant

• Gravida : a woman who currently is pregnant or

she has been in the past, irrespective of
the pregnancy outcome

• Primigravida, multigravida
 Definitions
• Nullipara: a woman who has never completed a
pregnancy beyond 20 weeks’ gestation

• Primipara: a woman who has been delivered only

once of a fetus or fetuses born alive or
dead with an estimated length of gestation
of 20 or more weeks

• Multipara: a woman who has completed two or more

pregnancies to 20 weeks or more
 Age of Gestation
1. Normal Pregnancy Duration

– Gestational age or menstrual age

- Clinicians
- 280 days = 40 weeks = 9 & 1/3 calendar
months  first day of the last menstrual
period
- Naegele’s rule  (DAY)+7, (MONTH)-3  40 wks

– Ovulation age = postconceptional age  ---

- Embryologists

– Sonographic examination
 Age of
2. Normal Pregnancy Duration
Gestation
– Fundal Height
– Fetal Heart Sounds
– Sonography

3. Trimester
– Trimester I
– Trimester II
– Trimester III
 History
1. Complaints

2. Prenatal Care

3. Past Medical History

4. Family Medical History

5. Past obstetrical History

6. Menstrual History

7. Contraceptive History

8. Social History

9. Habbits
 Physical Examination

- Vital signs
- Maternal weight
- Pelvic/ cervical examination
- Fundal height
- Fetal heart rate/ position
Fundal height
 Leopold Examination
• Leopold I
 Leopold Examination
• Leopold II
 Leopold Examination
• Leopold III
 Leopold Examination
• Leopold IV
 LABORATORY

1. Hematocrit or hemoglobin
2. Blood type and Rh factor
3. Glucose tolerance test
4. Urinalysis
5. Hepatitis B serology
6. HIV serology
7. Neural tube defect screening
8. Syphillis
9. Pap smear
 HIGH RISK
PREGNANCY
 HIGH RISK
PREGNANCY
 HIGH RISK
PREGNANCY
 HIGH RISK
PREGNANCY
 Prenatal Surveillance
1. Fetal

– Heart rate(s)
– Size—current and rate of change
– Amount of amnionic fluid
– Presenting part and station (late in pregnancy)
– Activity
2. Maternal

– Blood pressure

– Weight – BMI

– Symptoms — including headache, altered

vision, abdominal pain, nausea and vomiting,
bleeding, vaginal fluid leakage, and dysuria

– Height in centimeters of uterine fundus from

symphysis – EFBW
– Vaginal examination late in pregnancy :

1. Confirmation of the presenting part and

its station

2. Clinical estimation of pelvic capacity and its

general configuration

3. Consistency, effacement, and dilatation of

the cervix
 NUTRITION
• Recommendations for Weight Gain
Recommended Dietary Allowances
• Exercise
Miscellaneous
• Backache
• Fish Consumption • Varicosities
• Travel • Hemorrhoids
• Coitus
• Heartburn
• Immunization
• Caffeine • Ptyalism
• Nausea and • Sleeping and
Vomiting Fatigue
• Leukorrhea
THANK YOU