The Antepartal period

Assessment

Classification of pregnancy

A. Gravida: number of times pregnant, regardless of duration, including the present

pregnancy.
1. Primagravida: pregnant for the first time
2. Multigravida: pregnant for second or subsequent time
B. Para: number of pregnancies that lasted more than 20 weeks, regardless of outcome.
1. Nullipara: a woman who has not given
birth to a baby beyond 20 weeks’ gestation.
2. Primipara: a woman who has given birth to one baby more than 20 weeks’ gestation.
3. Multipara: Woman who has had two or more births at more than 20 weeks’
gestation. . . twins or triplets count as 1 para. (the number of pregnancies is counted
and NOT the number of fetuses. Multiple pregnancy therefore, does NOT increase the
parity.)
4. TPAL: Para subdivided to reflect births that went to Term, Premature births,
Abortions, and Living children.
Use of GTPAL: Pregnancy outcomes can be described with the acronym
GTPAL.
1. G is gravidity, the number of pregnancies, including the present one irrespective of
the outcome.
2. T is term births, the number born at term (longer than 37 weeks' gestation).
3. P is preterm births, the number born before 37 weeks' gestation.
4. A is abortions and/or miscarriages, the number of abortions and/or miscarriages
(included in gravida if before 20 weeks' gestation; included in parity if past 20 weeks'
gestation). Note that a termination of the pregnancy after 20 weeks is referred to as a
“therapeutic termination.”
5. L is the number of current living children.
May is 6 weeks pregnant. Her previous two pregnancies ended in alive birth at 41
weeks.
G T P A L
3 2 0 0 1

Susan is experiencing her fourth pregnancy. Her first pregnancy ended in a spontaneous
abortion at 8 weeks, the second resulted in the live birth of twin boys at 38 weeks, and
the third resulted in the live birth of a daughter at 34 weeks.
G T P A L
4 2 1 1 3
 Determination of Birthdate
Naegele’s rule
Is a standard way of calculating the due date for a pregnancy.
The rule estimates the expected date of delivery (EDD) by adding one year, subtracting
three months and adding seven days to the first day of a woman’s last menstrual period
(LMP)
The result is approximately 40 weeks from the start of the last menstrual period
Another method is adding 9 months and 7 days to the first day of the last menstrual
period
For LMP between April to December
- 3(months) +7 (days) + 1 (year)

Example:
LMP= May 8, 2019

5 8 2019
-3 +7 +1
2 15 2020

EDD/EDC= February 15, 2020

For LMP between January to March

+ 9 (months) + 7 (days)

Example:
LMP=January 15, 2018

1 15 2018
+9 +7
10 22 2018

EDC: October 22, 2008

Determining the Age of Gestation (AOG)

Number of days since LMP to the present day divided by 7

Example:
A pregnant woman comes to the clinic for an initial prenatal check up. Her LMP was
December 16, 2019. Present day is February 14, 2019

December 15 (31 days- 16 days)

January 31
February 14
60 days/7 = 8 weeks and 4 days AOG
Seatwork
A pregnant woman comes to the clinic for an initial prenatal check up. Her LMP was
November 17, 2017. Present day is April 10, 2018
November 13 (30 days – 17)
December 31
January 31
February 28
March 31
April 10
144 days/7= 20 weeks and 4 days

DETERMINATION OF PREGNANCY

Diagnosis of pregnancy is based on pregnancy-related physical and hormonal changes and are
classified as presumptive, probable, or positive.

Presumptive signs and symptoms (Subjective)

These changes may be noticed by the mother/health care provider but are not conclusive for
pregnancy.

A. Amenorrhea (cessation of menstruation)

B. Nausea and vomiting
C. Urinary frequency
D. Fatigue
E. Breast changes
F. Weight change
G. Skin changes
Linea nigra- Line of dark pigment on the abdomen
Melasma- Dark pigment on face
Striae gravidarum- Red streaks on abdomen
H. Vaginal changes including leukorrhea
I. Quickening

Probable Signs and Symptoms (Objective)

These changes are usually noted by the health care provider but are still not conclusive for
pregnancy.

A. Uterine enlargement
B. Changes in the uterus and cervix from increased vascularity
C. Ballottement: fetus rebounds against the examiner’s hand when pushed gently upwards.
D. Braxton Hicks’ contractions: occur early in pregnancy, although not usually sensed by the
mother until the third trimester.
E. Laboratory tests for pregnancy
F. Changes in skin pigmentation.

Laboratory tests for pregnancy

1. Most tests rely on the presence of HCG in the blood or urine of the woman.
2. Easy, inexpensive, but may give false readings with any handling error, medications, or
detergent residue in laboratory equipment.
3. Exception is the radioimmunoassay (RIA), which tests for the beta subunit of HCG and is
considered to be so accurate as to be diagnostic for pregnancy.

Positive signs and symptoms

These signs emanate from the fetus, are noted by the health care provider, and are conclusive
for pregnancy.

A. Fetal heartbeat: detected as early as eighth week with an electronic device; after 16th week
with a more conventional auscultory device.
B. Palpation of fetal outline.
C. Palpation of fetal movements.
D. Demonstration of fetal outline by either ultrasound (after sixth week) or X-ray (after 12th
week).

Assessment

Assess patient’s symptoms

Quickening: Maternal feeling of the fetus move, the earliest usually around 16 weeks
Ballottement: examiner inserts finger into the vagina, pushes on uterus and feels the
return of the fetus to the finger
Chadwick’s sign is a purple/blue/violet discoloration of the cervix, labia and vagina due
to increased vascularity and blood flow
Hegar’s sign is a softening at the bottom of the uterus, usually around 4-6 weeks
Goodell’s sign is at approximately 4 weeks gestation, the vaginal portion of the cervix
gets softer due to increased vascularization

Fundal Height

A. Fundal height is measured to evaluate the gestational age of the fetus

B. During the second and third trimesters (weeks 18 to 30), fundal height in centimeters
approximately equals fetal age in weeks ± 2 cm
 C. At 16 weeks, the fundus can be found approximately halfway between the symphysis
pubis and the umbilicus.
D. At 20 to 22 weeks, the fundus is approximately at the location of the umbilicus.
E. At 36 weeks, the fundus is at the xiphoid process.

Measuring fundal height

1. Place the client in the supine position.

2. Place the end of the tape measure at the level of the symphysis pubis.
3. Stretch the tape to the top of the uterine fundus.
4. Note and record the measurement.