Antepartum Period

Classification of Pregnancy:
I. Gravida-number of time pregnant, regardless of duration, including the present pregnancy.
1.Primagravida –pregnant for the first time
2.Multigravida –pregnant for second or subsequent time
II. Para –number of pregnancies that lasted more than 20 weeks, regardless of outcome.
Nullipara—a woman who has not given birth to a baby beyond 20 weeks’ gestation
Primipara—a woman who has given birth to one baby more than 20 weeks’ gestation.
Multipara—woman who has had two or more births at more than 20 weeks’ gestation... twins or
triplets count as 1 para.
TPAL M—para subdivided: Term, Premature births, Abortions, and Living children, Multiple
pregnancy
Term –38 –42 weeks
Postdate / Post term ->42 weeks
Preterm –21 to 37 weeks
Abortion -< 20 weeks
DIAGNOSIS OF PREGNANCY
Presumptive (Subjective) Signs of Pregnancy
•Presumptive signs of pregnancy are those that are least indicative of pregnancy.
Probable (Objective) Signs of Pregnancy
•In contrast to presumptive signs, probable signs of pregnancy are objective so can be
documented by an examiner.
Positive Signs of Pregnancy
There are only three documented or positive signs of pregnancy:
1.Demonstration of a fetal heart separate from the mother’s
2.Fetal movements felt by an examiner
3.Visualization of the fetus by ultrasound
INTERVENTIONS
Prenatal care
The purposes of prenatal care are to:
1.Establish a baseline of present health
2.Determine the gestational age of the fetus
3.Monitor fetal development and maternal well being
4.Identify women at risk for complications
5.Minimize the risk of possible complications by anticipating and preventing problems before
they occur
6.Provide time for education about pregnancy, lactation, and newborn care
TIME FRAME
1.First visit: may be made as soon as woman suspects she is pregnant; frequently after first
missed period.
2.Subsequent visit: Every mon. until the 8th mon., every 2 weeks during the 8th month and
weekly during the 9th mon more frequent visits are scheduled if problem arise
CONDUCT OF THE INITIAL VISIT
Screening includes an extensive health history, a complete physical examination, including a
pelvic examination, and blood and urine specimens for laboratory work. Manual pelvic
measurements can be taken to determine pelvic adequacy.
Extensive collection of data about client in all pertinent areas in order to form basis for
comparison with data collected on subsequent visits and to screen for any high-risk factors.
a. Menstrual history
b. Obstetrical history
c. Medical history
d. Family history/ psychosocial
data
e. Information about the father-to-be may also be significant
f. Current concerns
MEASUREMENT OF FUNDAL HEIGHT AND FETAL HEART SOUNDS

➢If a woman is past 12 weeks of a pregnancy, palpate the fundus location, measure the fundal
height (from the notch above the symphysis pubis to the superior aspect of the uterine fundus).

➢Auscultate for fetal heart sounds (120 to 160 beats per minute). These can be heard at 10 to 12
weeks if a Doppler technique is used but not until 18 to 20 weeks if a regular stethoscope is used.
Palpate for fetal outline and position after the 28th week as a further estimation of fetal size and
growth.
Conduct of subsequent visit
1.Continue collection of data, especially weight, blood pressure, urine screening for glucose and
protein, evaluation of fetal development through auscultation of fetal heart rate (FHR) and
palpitation of fetal outline, measurement of fundal height as correlation for appropriate progress
of pregnancy.
2.Prepare for necessary testing.
a. Have client void (clean catch)
b. Collect baseline data on vital signs
c. Collect specimen
d. Monitor client and fetus after procedure
e. Provide support to client
f. Document as needed
Sexual Activity
Sex is contraindicated in the following situations:
Spotting or bleeding
Incompetent cervical os
Ruptured BOW
Sexual Positions
Side by side 
Rear entrySide lying, facing each other
Exercise is contraindicated
PIH
PROM
PTL (preterm labor)
Incompetent cervix
Vaginal bleeding
Recommended Exercises
Squatting and Tailor Sitting
Kegel’s Exercise
Pelvic
DISCOMFORTS OF EARLY PREGNANCY: FIRST TRIMESTER
1. Breast Tenderness
2. Palmar Erythema
3. Constipation
4. Nausea, Vomiting, and Pyrosis
5. Fatigue
6. Muscle Cramps
7. Hypotension
8. Varicosities
9. Hemorrhoids
10. Frequent Urination
11. Abdominal Discomfort
12. Leukorrhea
Discomforts of Middle to Late Pregnancy
1.Backache
2.Headache
3.Dyspnea
4.Ankle Edema
5.Braxton Hicks Contractions
HIGH RISK MOTHER
1. Pregnancy:
a) lack of prenatal care
b) under 18 y.o. or over 35 years of age
c)conception within 2 months of previous delivery
d)first / fifth or subsequent delivery
e) pre-pregnant weight 20% or more or less than normal
f) minimal or no weight gain
g) fetal anomaly
h) labor and delivery complication -e.g. eclampsia, precipitous delivery
I) history of spontaneous abortion
Danger Signs of Pregnancy
a) Epigastric Pain
b) Severe continuous headache
c)Blurring/dimness of vision or flashes of light or dots/spots before the eyes
d)Edema lower legs, hands, and face
e) Rupture Membrane
f) Bleeding from the vagina
g) Persistent vomiting
h) Abdominal Pain
i)Fever/Chills
j) Absence/Cessation of fetal movement