PRENATAL CARE
breastfeeding
-care of a pregnant woman
-comprehensive health supervision of
a pregnant woman before delivery
-it is planned examination,
observation and guidance given to
the pregnant woamn from
conception till the time of labor.
WHO
-emphasized that mothers should
observe the quantity and periodity
of prenatal visits.
~Goal in the Philippines
 To have 80 % of pregnant
women with atleast 4 prenatal
visits. “study found that birth
outcomes for women who
receive no prenatal care 2-4x
worse than those who
received prenatal care.”
(In 2015 around 830 woman died
everyday from problems in
pregnancy and childbirth)
3 MAIN CATEGORIES
1. Assessment
–history taking, physical
examinatin, laboratory test to
identify problems/ risk factors
2. Health Promotion
 Nutrition, planning the birth,
information on danger signs
of pregnancy,
contraception and
3. Care Provision
 Iron and sulfate forate
supplements, tetanus
toxoid immunizations,
psychosocial support and
record keeping.
Goal of Prenatal Care
 To optimize the health of
the woman and the fetus
and to increase the odds
that fetus must be born
healthy to a healthy
mother
OBJECTIVES:
 Maintenace of health of
mother during pregnancy.
 Identification of high risk cases
and appropriate
management.
 Prevent development of
complications.
 Decrease maternal and infant
mortality and morbidity.
 Remove the stress and worries
of the mother regarding the
delivery process
 Teach the mother about child
care, nutrition, vanitation and
hygiene.
 Advice about family planning.
PROVIDERS OF PNC  Social profile
 Gynecologic
 Doctor
 Ostetric history
 Nurse
 Physical assessment
 Midwife
 Measurent of fundal height
Schedule for antenatal visits  Fetal heart sounds
 Pelvic examination
 The first or initial visit should  Examinating the pelvic size
be made as early in  Laboratory assessment
pregnancy as possible.
Signs and symptoms
Return visits:
 PRESUMPTIVE SIGNS
 Once every month till - Subjective changes that
28 weeks are experienced and
 Once every 2 weeks reported by the woman.
till the 36 weeks - Least reliable indicators of
 Once every weeks, pregnancy. It includes:
till labor o Amenorrhea
o Morning sickness
The world health organization (WHO)
o Fatigues
recommends a minimum of four
o Breast changes
antenatal visits
o Quickening
 1st visit 4 months o Frequency of
 2nd visit 6 months micturation
 3rd visit 8 months o Skin changes
 4th visit 9 months
AMENORRHEA

ASSESSMENT
First prenatal visit – longest confirm or
rule out pregnancy history
 Demographic data
 Chief complaint
 Family profile
 History of past illness
 History of family illness
- Absence of menstruation in
woman of reproductive
age
- Since 9 months during
pregnancy periods are not
occurred
- If any type of bleeding is
occurred during 9 months
shot not be confused with
the commonly met
pathological bleeding
 Example: threatened abortion
MORNING SICKNESS
- Present in about 50% cases,
mostly during first
pregnancy
- Nausea and vomiting
begins about 6 weeks after
the last menstrual period
and usually disappear
about 14 weeks
- Due to the high level of
pregnancy hormones.
Hyperemisis Gravidarum-
excessive vomiting
FREQUENCY OF
MICTURATION(urination)
- Resting of bulky uterus of
the fundus of the bladder
because of anteverted
position of uterus
- Is present during 8-12 weeks
of pregnancy and subside
after 12 weeks
BREAST DISCOMFORT
- Present during 4th week in
the form of feeling of:
o Tenderness
o Tingling
o Fullness
o Increase in size
o Pigmentation of areola
o Picking sensation
FATIGUE
- Frequent in early
pregnancy and subside
around 12-14 weeks of
pregnancy with bringing
renew energy.
UTERINE CHANGES
A. Size shape and consistency
Uterus enlarged to:
o Size of hens eggs at 6th
week
o Size of cricket ball at 8th
weeks
o Size of fetal head at 12
weeks
o Pyriform shape of non-
pregnant uterus
becomes globular by
12th week
o There may be
asymmetrical
enlargement of uterus if
there is lateral
implantation.
o One half is more firm
than other half
QUICKENING
- Fetal movement felt by
mother
Primi- 5th month
Multi- 4th month
Linea nigra
- Line of dark pigment on the
abdomen
Melasma
- Dark pigment on face
Striae gravidarum
- Red streaks of abdomen
 PROBABLE SIGNS
- Can be documented by
the examiner
- More reliable than
presumptive
Serum laboratory test- blood
serum reveal the presence of
hCG
Chadwick’s sign- color
change of the vagina from
pink to purple
Goodell’s sign- softening of
the cervix
Hegar’s sign- softening of the
lower uterine segment
Braxtons hicks contraction-
periodic uterine tightening
Balloment- when lower uterine
segment is tapped on a
bimanual examination, the
fetus can be felt to rise against
abdominal wall
Sonographic evidence of
gestational sac- characteristic
ring is evident
Fetal outline felt by the
examiner- can be palpated in
abdomen
 POSITIVE(+)
- Sonographic evidence of
fetal outline can be seen
and measured in sonogram
- Fetal heart is audible
- Fetal movement felt by the
examiner
FAMILY PROFILE
o Size of house –space for
baby’s bed, upstairs restriction
o Level of education- level of
teaching
o Occupation- heavy lifting,
long standing
o Support people
HISTORY OF PAST ILLNESS
Allergies- more likely to breastfeed
than bottlefeed
Drug sensitivity
Previous surgery- adhesions may
interfere with uterine growth
OBSTETRIC HISTORY
1. Past medical surgical history-
some medical conditions may
have impact on the course of
the pregnancy or the
pregnancy may have an
 impact on the medical - medication history
conditions. Examples: - illicit drugs
o Heart disease - domestic vilence
o Hypertension
GYNECOLOGICAL HISTORY
o DM
o Epilepsy - menstruation
o Thyroid disease - menarche
o Bronchial - cycle
asthma - interval
o Any previous - part surgery of
surgery reproductive treat
o Kidney - duration
diseases - amount
o UTI - discomfort
o Autoimmune
disease OBSTETRIC HISTORY
o Psychiatric
Gravidity – the number of time a
disorder
woman has been pregnant
o Hepatitis
o Blood GP SYSTEM
transfution
Gravida and para- terms used to
HISTORY OF FAMILY ILLNESS describe a womans childbearing
history
- to identify potential
problems Gravid – means pregnant
- health history-chronic and
Gravida- the no. Of times the
infections,
woman has been pregnant
genetic/congenital
anomalies Nulli-null or none
- heredity(thalassemia),
multigestation Primi-first or one

SOCIAL PROFILE Multi-many

- nutrition, elimination, sleep,

recreation, interpersonal
interactions
- smoking
- alcohol intake

NULLIGRAVIDA, PRIMIGRAVIDA,
MULTIGRAVIDA
Para- the no. Of infants delivereed
after 20 weeks gestation, born dead
or alive
Age of viability- the earliest age at
which fetuses could survive
Abortion-any pregnancy
terminatedd before the age of
viability; miscarriage
Multiple births- count as one delivery
regardless of the number of infants
delivered
GTPAL SYSTEM
Gravida- a woman who is of has
been pregnant regardless of length
of pregnancy
TPAL- more detailed description of
para
- important in deciding when
to schedule certain test or
procedures
- subtract 3 months, and 7
days and add 1 year
LNMP- the basis of the first day
of computing EDD
ESTIMATES IN PREGNANCY
Determining Age of Gestation
- the no. of days since LMP to
the present day divided by
7
example:
a pregnant woman comes to
clinic for initial prenatal check
up. Her LMP was july 20, 2019.
The present days is September
13, 2019.

T- no. of infants born at 37 weeks

before 42 weeks

P- no. of infants born at 20 weeks

and before 37 weeks

A – no. of pregnancies that end in MC DONALD’S RULE

spontaneous or therapeutic abortion
- a measure of the size of the
prior to 20 weeks
uterus used to assess
L- no. of children currently alive - fetal growth and
development during
ESTIMATED DATE OF DELIVERY
pregnancy
Nagele’s rule
 Example:

A fundic height of 28cm, and

the fetus is not engaged.

28cm -11 x 155 = 2635 grams

formula:
OBSTETRIC HISTORY

o history of delivery
BARTOLOME’S RULE o medications taken
o prenatals
- estimates AOG by the
o complications (spotting,
relative position of the
swelling,
uterus in the abdominal
infection,surgery)
cavity.
o anesthesia
32-34 cm (34-38 weeks)

30-32 cm (30-34 weeks)

PHYSIOLOGICAL CHANGES
28 cm (26-30 weeks)
Womans body- make tremendous
24 cm (22-24 weeks) changes to accommodate a
pregnancy. Maintain all vital
20 cm (20-22 weeks) functions of the body and of the
growing fetus.

Structural of hormonal
JOHNSON’S RULE
1. Reproductive changes
- used to estimate the weight
- no shedding of endometrial
of the fetus in grams
lining, uterus expands of
formula: estrogen, Broxton hicks’s
- increase vascularity and in
fundic height in cm = n x k
glandular (E & P)-
k is constant = always 155 responsible for Hegar’s,
Goodell’s, Chadwick’s
n is 12 if the fetus is engaged - thick mucuos plug- protects
11 is the fetus is not yet uterine cavity from
engaged infection

Breast
- tender, tingling, increases in
size
- produce
colostrum(foremilk) a thick
yellow fluid rich in
antibodies and CHON
2. Endocrine changes
- pituitary gland enlarge by
135%
- prolactin increases- initiates
lactation
- oxyticin- responsible for
uterine contraction,
stimulates
- thyroid gland increase in
size, increase feed for
insulin
3. Hematologic changes
- Blood volume increases 40-
45%, are high level= 12.5g
- Venoustasis and
hypercoagulability-
protects woman from
blood loss during delivery
4. Cardiovascular changes
- increased workload due to
demands of uterus and
other organs
- BP decreases- 2nd trimester,
HR rises by 10-15 bpm
- Woman lie flat- uterus
compress the aorta and
vena cava against the
spine
- Light headed, dizzy, pale,
clammy
5. Respiratory changes
- Vasocongestion of URT
lining- common cold nasal
congestion and voice
changes, nosebleed
- Uterus pushes up to
diaphragm- dyspneic
- Increase thoracic diameter
6. Musculoskeletal
- Pregnancy alters the center
of gravity
- Lordosis counterbalance
the effect of protruding
abdomen
- Low back ache increased
curvature
- Increased mobility in pelvic
joints- low back discomfort
7. GI changes
- Ptyalism- large increase in
saliva production
- Pyrosis(heartburn)
- Delayed gastric emptying
and decreased peristalsis
8. Urinary chages
- Glycosuria- kidney tubules
may not reabsorb muck
glucose
- Urinary frequency- 10th
week first and second
trimester pressure to the
bladder
9. Integumentary changes
- Chloasma
- Linea nigra
 - Striae- response to Turn to side first before getting out of
glucocorticoid level bed, squat, bring knees up to chest,
avoid strenuous exercises.

5.URINARY FREQUENCY - pressure on

DISCOMFORS OF PREGNANCY
bladder
1. N/V - acue on arising
-first tri and lightening (descent of
*eat chicken cracker, dry toasts, 5-6 uterus into the pelvic cavity)
small meals, avoid strong odors,
- KEGEL'S contract the muscles
gingers, peppermint, CHON, avoid
around the vagina and hold for 10
high fat, greasy, fried, spicy
sec
2. HEARTBURN- acute burning
-stop midstream urine
sensation in the epigastric and
sternal regions 6.VARICOSITIES- occurs in obese,
multipara
-REVERSE PERISTALTIC WAVES causes
regurgitation of acidic stomach -weight of uterus compresses the
contents into esophagus veins returning from legs-vessel
dilate-valves become stretched and
- eliminate smoking and coffee,
incompetent- engorged, inflamed
remin upright for an hour, deep
and painful
breath
-avoid crossing legs, constricting
3. BACKACHE- 3rd tri, stooping or
clothing- impedes blood return
bending strains muscles
-elevate legs above hip level
-correct posture (headup and
shoulders back and body -apply support hose or support
mechanics, exercise, avoid high stockings before rising
heeled shoes squat rather than
-walk around every 2 hours to
bend, shoulder circling, pelvic rock,
stimulate blood flow and relieve
tailor sitting
discomfort
4.ROUND LIGAMENT PAIN- sharp pain
7. HEMORRHOIDS- varicosities of the
in the side of inguinal area resulting
rectum
from softening and stretching of the
ligament from hormones and uterine -constipation, prolonged sitting
growth. standing
-establish a regular pattern of bowel
elimination
-drink plenty of water, eat foods rich
in fiber and exercise regularly
8 CONSTIPATION - hard, dry that are
difficult to pass
-persist from several weeks or longer
reduced intestinal motility
-foods high in fiber - unpeeled fresh
fruits, vegetables, cereals, oatmeal,
restrick cheese
9.LEG CRAMPS- painful contraction
of the muscles of the lower legs
-Imbalance of serum, calcium,
phosphorus, low in magnesium
-extend legs, keep knee straight,
bend foot toward the body
10. HEART PALPITATION
-Acing, pounding, skipped/added a
beat-palpitation d/t circulatory
adjustments necessary to
accommodate increase blood
supply
-gradual, slow movement
11. LEUKORRHEA- whitish, viscous
vaginal discharge - response to high
estrogen and increased blood
supply to vagina and cervix
-daily bath or shower, wear cotton
underwears
12. BREAST TENDERNESS - minimal
and transient
-wear bra with wide shoulder strap
for support
13. PALMAR ERYTHEMA (PALMAR
PRURITIS) - redness and itching
-due to increased estrogen levels
-calamine lotions
14. ANKLE EDEMA- Swelling of ankle
and feet caused by reduced
circulation due to uterine pressure
and fluid retention
-as long as proteinuria and
hypertension are absent
-left side lying, elevates legs
HEALTH PROMOTION DURING
PREGNANCY
*SELF CARE NEEDS-separate fact
from fiction
1.BATHING
*TUB BATH- vagina is closed, water
entering the cervix is minimal except
when membranes rupture, vaginal
bleeding, cervix is open
*WATER TEMP- no documented
effects on initiation of labor
2. BREAST CARE- larger bra for
increased breast size
*wash breast with clear tap water. If
Breast Milk is profuse, place gauze or
breast pads
3. DENTAL CARE- routine exam and
cleaning
*TOOTH DECAY- occurs from the
action of bacteria to sugar
4. PERINEAL HYGIENE - douching-can
lead to infection, alters pH of vagina
5. DRESSING - maternity wardrobe
*avoid garters, girdles, knee high
stockings- impedes lower extremity
circulation. Shoes with low to
moderate heel to minimize
backache
6. SEXUAL ACTIVITY
MYTH
*coitus on the expected date
initiates labor
*orgasm will initiate labor
*coitus during fertile days of a cycle
will cause 2nd pregnancy
*coitus might cause rupture of
membranes
FACTUAL
*Women with hx miscarriage,
ruptured membranes, vaginal
bleeding
*decrease desire for sex-increase
estrogen
*as abdomen increases- need for
new position- side lying, superior
*caution women with non-
monogamous sexual partner
7. EXERCISE - prevents circulatory
stasis
*ACOG american college of
obstetrics and gynecologist -
average well nourished women
exercise for 30 mins daily
*5 mins warm up , 20 mins "active
stimulus", 5 mins "cool down"
*depends on womans
cardiopulmonary fitness
*exercising too strenuously - continue
talking while exercising - SOB
*swimming - relieves backache
*walking- best exercise
8. SLEEP - growth hormone secretion
is at the highest level
*drink a glass of milk
*awakened- due to fetal movement,
pyrosis, dsypnea
*sims position
9. EMPLOYMENT

*exposure to toxic susbstance,

excessively physical strain, long
standing

*PUBLIC LAW 95-5555 - pregnancy

discrimination act 1978 requires
employers to treat pregnant women
the same way they do all other
workers a job applicants

10. TRAVEL

*early labor, eat cooked food, rest

periods for long trips, driving women
- use seat belts, comfort behind
steering wheel, plane

10.