4. The PRENATAL VISIT
The primary factor in the improvement of
maternal & infant morbidity & mortality
statistics.
5. Components of prenatal visit
Purposes:
• Establishing rapport
• Gaining information about her physical and
psychosocial health
• Obtaining basis for anticipatory guidance for
the pregnancy
6. Schedule of Pregnancy Visits
• Should be at least 4 times of the entire
duration of pregnancy (DOH
recommendation)
• Once every trimester or once after 4 weeks *
• 3rd Trimester : 8 month – additional visit
every other week or as recommendedby
physician
• 9 month – weekly or until laborbegins
7. 1.History-taking
a.Demographic data – name,age,
address, civil status ,email ad, phone
#, religion and health insurance info
b.Chief concern –reason for seeking
health
9. Interview Questions:
• Was the pregnancyintended?
• How did the pregnancy go, overall?
• Did she have any complications, such as
vaginal spotting, swelling of her hands or feet,
falls, or surgery?
• Did she take any medication? If so, what and
why?
10. Interview Questions:
• Did she receive prenatal care? If so, when did she
start?
• What was the duration of the pregnancy?What was
the duration of labor?
• Was it what she expected? Worse?Better?
• What was the type of birth? Vaginal or cesarean?
Vertex or breech? In a healthcare facility or at home?
What type of anesthesia, if any, was used?
11. Interview Questions:
• Did she have stitches following birth?
• Did she have any complications following birth,
such as excessive bleeding orinfection?
• What was the infant’s birth weight and sex? Did the
infant cry right away? What was the infant’s Apgar
score?
• Was any special care needed for the baby, such as
suctioning, oxygen, or an incubator?
12. Interview Questions:
• Was the baby discharged from the healthcare
setting with her?
• What is the child’s present state of health?
13. g. Obstetrical Data/ History
1. Gravida - # of pregnancies the woman has had
2. Para - # of viable pregnancies, regardless of # & outcome
3. TPAL score - # of full term babies (T),premature (P),
abortion (A), living children (L)
4. past pregnancies
- method of delivery
- where?
- risks involved
14.
15. 4. present pregnancy
- chief concern
- danger signals:
- vaginal bleeding/ spotting swelling of face or fingers
severe continuous headache
- dimness or blurring vision
- flashes of light or dots beforeeyes
- pain in the abdomen
- chills & fever
- sudden escape of fluid from thevagina absence of FHT,
fetal movement
16. h. Medical data
History of :
• cardiac,
• kidney or liver disease,
• HPN,
• TB,
• STDs,
• HepaB
17. 2. Assessment
a. PhysicalAssessment
b. Pelvic exam
Important! -empty the bladder 1st
1. IE and Bimanual Examination
2. ballottement – sharp upward pushing of the uterine wall
with the finger inserted to vagina for diagnosing pregnancy
3. Pap smear
4. Pelvic measurement – X-ray pelvimetry 2wks prior to
EDC
21. Papanicolau Smear
A Pap smear is taken from the endocervix at a
first prenatal visit to be certain a
precancerous or cancerous condition of the
uterine cervix, vulva, or vagina is not present
22.
23.
24.
25. MC. DONALD’S Method & Rule
( measuring of FUNDIC HEIGHT using tape measure)
FORMULA: In months : Fundic Height(cm) multiplied(x)2/7
EXAMPLE:
25 cm X 2 = 50 = 7 months
7 7
In weeks: Fundic Height (cm) multiplied (x) 8/7
EXAMPLE:
25 cm X 8 = 200 = 28 to 29 week
7 7
26. FETAL MOVEMENTS
*Quickening ( first fetal movements ) felt by
mother at 18-20 weeks, and peaks at 28 -
38 weeks in 10 movements/day;
* Decreased movement : placental
insufficiency, instruct woman to seek
consultation and tell her that fetal
movements vary in relation to mother’s
activity
27. FETAL HEART RATE
* 5-8th week, heart beat seen in
Ultrasound;
*10th-11th weeks heard with ultrasonic
doppler;
*16 weeks heard at fetoscope
* 120-160 bpm ( beats per minute)
29. COMPUTATION / CALCULATION
EDC/EDD : NAGELE’S RULE
1. ask for the LMP of the client.
FORMULA: months from APRIL - DECEMBER
-3 + 7 +1
( subtract 3 months/add 7 days/add 1 year)
months from JANUARY- MARCH
+9+7 + 0
( add 9 months/add 7 days/ do not add 1 yr)
30. b.3 COMPUTATION OF AGE OF GESTATION (AOG) (TINAMBAN
STYLE) or CALCULATION by FINGER/ KNUCKLES
Last Menstrual
Period(LMP)
Nov. 19,2020
Assessment Date:
July 27, 2021
31. 3. Important Features to Assess
A. Estimated Date of Birth(EDB) or Estimated Date of Confinement
(EDC) or Estimated Date of Delivery (EDD)
A. 1. NAGELE’S RULE – (-3) Months (+7) days (+1) year
Ex: LMP is November 19, 2020
LMP 11 – 19 – 20
-3 +7 +1
EDC/EDD/EDB =08 – 26 – 21 (August 26,2021)
34. Cont. LMP/EDC/AOG
Method of Calculation of
AGE OF GESTATION ( AOG)
by weeks
1. ask client’s first day of Last Menstrual Period
(LMP)
2. subtract the date of LMP from the total no. of
days of the same month
3. add the difference to the present date of the
month when the client had consulted/visited the
clinic( present prenatal visit)
35. Practice:
• LMP:
1. December 15,2021 - Date of clinic visit : May 22, 2022
2. February 28,2022 - Date of clinic visit : July 16, 2022
3. April 9, 2022 - Date of clinic visit : Aug. 17, 2022
36.
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