Handout #11 5.

Ovulation that occurs after cessation of ovulation

EDD & AOG Computation inhibition method of contraception may be delayed

Naegele’s Rule:
EXPECTED DATE OF DELIVERY & AGE OF GESTATION
 Inquire for last menstrual period (LMP) &
Once pregnancy is confirmed, it is important to next
calculate for expected date of
determine the age of gestation & the expected date of
delivery/confinement (EDD/EDC)
delivery.
Example:
The clinically most appropriate unit of measure of
Month Day Year
gestational age is weeks of gestation completed.
LMP 4 (April) 3 2004
Two methods used are the:
-3 +7 +1
1. Menstrual age/Gestational age
EDC 1 (Jan) 10 2005
 Menstrual from LMP. The
Naegele’s Rule: (Other way of Computation)
average duration of pregnancy
a. Determine the last normal LMP.
using the menstrual age is 280
b. Consider the 1st day of the LMP.
days.
c. Consider the month in numeric terms.
2. Ovulatory age/Fertilization age
eg. July – 7; August – 8
 Measures from the date of
For the 1st 3 months of the year, add 12 to the
ovulation or fertilization. The
numerical value
average duration of pregnancy
Eg. Jan. : 1 + 12 = 13
from ovulation is 267 days.
Feb.: 2 + 12 = 14
 
March: 3 + 12 = 15
THE PARAMETERS THAT CAN BE USED TO ESTIMATE
Naegele’s Rule: (Other way of Computation)
EDC & MEASURE THE DURATION OF PREGNANCY ARE
d. Now use Naegele’s formula: Subtract 3 months and
THE FF:
add 7 days to the 1st day of the LMP.
A. Last Menstrual Period
Example: LMP is March 5-10, 2008. The numerical value
 This involves calculating the length of time from
of March is 3.
the last menstrual period up to the present.
15 5
Problems encountered w/ the use of the LMP are the
-3
following:
12 5
1. Failure to record LMP
+ 7
2. Menstrual cycles may be irregular & variable
12 12 EDD: Dec. 12
3. Pregnancy may follow immediately w/o menstruation
Mittendorf’s Rule:
in between gestation
An alternative to Naegele’s Rule in determining the
4. Implantation bleeding may be mistaken as
EDD.
menstruation
a. Determine the 1st day of the LMP.
 b. Categorize the woman as Caucasian or non- possible during pregnancy (age of gestation) for the
Caucasian (race). client.
c. Identify her gravidity: primigravida (G1) or The earlier the ultrasound is performed in pregnancy,
multigravida (G2 or above) the more accurate is the EDC & AOG:
Mittendorf’s Rule:  1st trimester ultrasound gives
For primigravid Caucasian women: EDC +/- 5 days
Formula: LMP + 15 days (constant) – 3 months = EDD  2nd trimester EDC +/- 10 days
Example A: What is the EDD of Mrs. Smith, a G1  3rd trimester EDC +/- 3 weeks
Caucasian w/ LMP of May 14? E. Assessment of Fundic Height
M D Fundic height increases as the fetus inside the uterus
5 14 grows.
- 3 + 15 Thus, it should be measured every visit to help
2 29 EDD: Feb 29 determine fetal growth.
Mittendorf’s Rule: In addition, fundic height measurements will also help
For multigravid non - Caucasian women: estimate AOG & EDC.
Formula: LMP + 10 days (constant) – 3 months = EDD E. Assessment of Fundic Height
Example B: What is the EDD of Mrs. Peralta, a G2 The landmarks to be used in measuring the FH are the
Filipino woman (non-Caucasian) w/ LMP of Aug. 10? top of symphisis pubis, the umbilicus & the xiphoid.
M D To ensure accuracy, the woman should empty her
8 10 bladder & the same examiner should perform the
- 3 + 10 measurement at every examination.
5 20 EDD: May 20 F. MC DONALD’S RULE is used to calculate AOG
C. Quickening: Quickening usually occurs at 20 weeks in Fundic height (cm) X 2/7 = AOG in lunar months
primis & at 16 weeks in multis. Thus, if the woman Fundic height in (cm) X 8/7 = AOG in weeks
cannot remember her LMP, ask her when she 1 st felt the G. MODIFIED MC DONALD’S RULE
fetus move. Usually on the average of at least 10 times Simply remember the fundic height in cm. will
per day. approximate the gestational age from 36-38 weeks +/- 3
To get EDC for primigravida, add 22 weeks to the date weeks
of quickening H. BARTOLOMEW’S RULE is used to calculate AOG
To get EDC for multigravida, add 24 weeks to the date Height of fundus is used to determine AOG.
of quickening Fundic height is determined by palpation & by relating
D. Ultrasound to the different landmarks in the abdomen: umbilicus,
When a woman cannot accurately point out her last symphisis pubis, & xiphoid process.
menstrual period, ultrasound must be made as early as H. BARTOLOMEW’S RULE is used to calculate AOG
12 weeks – level of symphisis pubis
16 weeks – halfway between umbilicus & symphisis Can be detected at 12 weeks of gestation with a
pubis Doppler ultrasound
20 weeks – level of umbilicus Can be auscultated at 16 to 20 weeks with a fetoscope
24 weeks – 2 fingers above umbilicus Normal fetal heart rate (FHR) ranges from 120 to 160
28-30 weeks – halfway between umbilicus & xiphoid beats/minute
process ----End---
36 weeks – level of xiphoid process
40 weeks – at 34 weeks level due to lightening
Greater Fundic Height May Indicate:
Multiple pregnancy
Miscalculated due date
Polyhydramios
Hydatidiform mole
EXPECTED DATE OF DELIVERY & AGE OF GESTATION
Fetal weight may vary & this is due to:
Fetal weight may vary & this is due to:
The age-weight pattern of previous infants
An expected increase in weight of each successive
infant
Hereditary traits or acquired disorders may affect infant
size. These factors include: race, nutrition, DM,
preeclampsia, etc.
I. JOHNSON’S RULE is used to calculate fetal weight in
grams.
Fundic height (cm)
– N X K = fetal weight
K = 155 (constant)
N = 12 if engaged (do leopold’s to find out)
N = 11 if not yet engaged
J. HAASE’S RULE is used to determine length of fetus
During the 1st half of pregnancy, square the number of
months
During the 2nd half of pregnancy, multiply the number of
months by 5
K. Fetal Heart Sounds (rate)