ASSESSMENT OF FETAL WELL-BEING 6.

MATERNAL SERUM ALPHA-FETOPROTEIN

1. FETAL MOVEMENT
• can be felt by mother as quickening which begins approx.
18-20 weeks of pregnancy and peaks at 28-38 weeks.
Healthy fetus moves at least 10x a day
➢ SANDOVSKY METHOD- mother lying in left recumbent
position after meal and record how many fetal movements
she feels over the next hour; normal is twice every 10
minute or average of 10-12 x/hr
➢ CARDIFF METHOD- “count to ten”; the mother records the
time interval it takes for her to feel ten fetal movements,
usually occurs within 60mins.
2. FETAL HEART RATE
• can be heard and counted as early as the 10-11th week of
pregnancy by the use of ultrasonic doppler; normal is 120-
160 beats/minute
• a substance produced by the fetal liver that is present in
amniotic fluid and maternal serum; increase in maternal
serum AF indicates open spinal or abdominal defects and
determine chromosomal defects (down syndrome/trisomy
21)
7. TRIPLE SCREENING
• analysis of three indicators (serum alpha fetoprotein,
unconjugated estriol and HCG). Together they increase the
detection of trisomy 18 and 21. They are performed between
15 and 22 weeks and considered positive if all markers are
low
8. CHORIONIC VILLI SAMPLING
• biopsy and analysis of chorionic villi for chromosomal
analysis done at 10 - 12 wks. AOG to determine the fetus’
chromosomal condition

3. ULTRASOUND
• Diagnose pregnancy as early as 6weeks AOG
• Confirm presence, size and location of placental and amniotic
fluid
• Establish presentation and position of the fetus
• Predict maturity by measurement of the biparietal diameter
4. ELECTROCARDIOGRAPHY (ECG)
• recorded as early as 11th week of pregnancy
9. AMNIOCENTESIS
• aspiration of AF from the pregnant uterus for examination at
14-16 wks. AOG; test for fetal maturity
• Informed consent, empty bladder, encourage expression of
fears and concerns
10. AMNIOSCOPY
• inspection of the AF through the cervix and membranes
with an amnioscope to detect meconium staining

5. Magnetic Resonance Imaging (MRI) 11. PERCUTANEOUS UMBILICAL BLOOD SAMPLING

(CORDOCENTESIS OR FUNICENTESIS)
• aspiration of blood from umbilical vein for analysis
 12. FETOSCOPY • A comparison of blood pressure is made with the woman
• visualizing the fetus by inspection through a fetoscope. lying on her left side and on her back; an excessive increase
Helps in assessing fetal well-being in blood pressure when she rolls to the supine position
indicates increased risk of toxemia
13. BIOPHYSICAL PROFILE • To determine the onset of hypertension and proteinuria
• ombines 4-6 parameters into one assessment: • Mother is positive if diastolic blood pressure increases to 20
Amniotic fluid mm/hg at 5 minute interval
Placental grading and fetal heart activity
Fetal breathing movements
Fetal movement and fetal tone

DIAGNOSTIC TESTS
1. LABORATORY TESTS
• detecting the presence of human chorionic gonadotropin
(HCG), a hormone created by the chorionic villi of the
placenta, in the uterine or blood serum of the pregnant
women
• accuracy: 95-98%
• test are performed by radioimmunoassay (RIA), enzyme-
linked immunosorbent essay (ELISA), radio-receptor assay
(RRA)

2. HOME PREGNANCY TEST

• accuracy: 97%
• not accurate for those who take psychotic drugs like anti-
anxiety agents, also those with oral contraception. Oral
contraception should be discounted 5 days before the test.
Chadwick’s sign- bluish discoloration
3. Roll-Over Test (ROT)
Goodell’s sign- softening of cervix
• Performed to pregnant mother suspected to develop
Hegar’s sign- lower segment of uterus softens
Pregnancy Induced Hypertension (PIH) between
Braxton Hicks- contraction
28th and 32ndweeks of gestation
Ballotement- upward pushing
PHYSIOLOGIC CHANGES IN PREGNANCY:
1. Reproductive System:
A. Uterus:
• Enlarges and thickens
• Increases in fibro elastic tissue
• Change in shape fr. pear-like to ovoid
• Blood vessels increase in size
HEGAR’S SIGN – lower segment softens
B. Cervix:
• Vascular and edematous
• GOODELL’S SIGN – softening of the cervix
C. Vagina:
• CHADWICK’S SIGN – bluish discoloration
• LEUKORRHEA - ↑secretion/discharges
2. Abdominal Wall:
• Striae Gravidarum
• Melasma / Chloasma / Mask of Pregnancy
3. Breasts:
• Feeling of fullness
• Hyperplasia
• Darkening of areola
• Secretion of colostrum by 4th month
• Nipples are erected
4. Circulation:
• Circulating volume increases 30-50%
• Physiologic anemia & easily fatigability
• Increase cardiac output
• Decrease circulation to lower extremities,
varicosities
• Palpitation may occur
• Lightheaded- due to compression of inferior vena cava
(rolled towel under the woman’s right hip)
5. Skin color changes- inc. MELANIN production
• Striae gravidarum
• Linea negra
• Melasma
• Vascular spiders on the thigh (varicose
• veins)
• Increased perspiration
6. Respiration:
• Displaced diaphragm
• Lung expands laterally to compensate for shortness of
breath
7. Digestive System:
• Stomach & intestines are displaced
• Slow stomach peristalsis
• Delayed stomach emptying
• HEARTBURN/ PYROSIS: regurgitation of acidic stomach
contents through the cardiac sphincter into the esophagus
Management:
• Avoid fried & fatty foods
• Sips of milk at frequent intervals
• Small frequent meals taken slowly
• Bend at the knees not at waist
• Constipation/flatulence
• Nausea & Vomiting - Eat dry toast, dry cereal before getting
up out of bed
edema, • HYPEREMESIS GRAVIDARUM
• Hemorrhoids
• Appetite increases after first 3 months
 MANAGING DISCOMFORTS OF PREGNANCY
8. Urinary System: FIRST TRIMESTER
• Increases output a. Nausea and vomiting (morning sickness)
• Increases in frequency occurs first 3 months b. Palmar erythema - Calamine lotion
c. Urinary frequency – Kegel’s exercise
9. Musculoskeletal: d. Breast tenderness
• Lordotic position – due to e. Fatigue
backache/fatigue • Waddling gait/ f. Leukorrhea (increased vaginal discharge that is white in
Duck walk – low heeled/flat shoes color)
• Leg cramps due to: g. Headache
Pressure of the gravid uterus
Low calcium, Fatigue/Muscle Tense SECOND TRIMESTER and THIRD TRIMESTER
Management: a. Heartburn/ Heart Palpitations
• Increase calcium intake b. Ankle edema
• Dorsiflex the foot & press the knees c. Varicose veins
• Frequent period of rest d. Hemorrhoids
• Do not massage e. Constipation
f. Backache
10. Weight: g. Leg cramps
• First trimester – allowed: 1.5 – 3 lbs. h. Abdominal Pain
• 2nd and 3rd allowed: 10-11 lbs./trimester i. Shortness of breath
• Total allowable weight gain:20-25lbs/10-12 kg
• Distribution of weight gain: DANGER SIGNS IN PREGNANCY
1. Vaginal bleeding, no matter how slight
Fetus 7 lbs. 2. Swelling of the face & fingers
Placenta 1 lb. 3. Severe, continuous headache
Amniotic fluid 1.5 lbs. 4. Flashes of light before the eyes
Uterine weight 2 lbs. 5. Pain in the abdomen
Blood volume 1 lb. 6. Persistent vomiting
Weight of breast 1.5 – 3 lbs. 7. Chills & fever
Additional fluid 2 lbs. 8. Sudden escape of fluid from the vagina
Fat & fluid accumulation 4 – 6 lbs.
20-25 lbs.
PRENATAL SELF CARE NEEDS
• BATHING- daily tub or showers due to sweating that tends
to increase in pregnancy
• BREAST CARE - wearing firm supportive bra with wide straps
to spread weight across the shoulders. Wash breast with
clear tap water (no soap) to remove or minimize infections.
• DENTAL CARE - good tooth brushing habits
• PERINEAL CARE - douching is contraindicated due to force
of the irrigation that can cause it to enter the cervix and lead
to infection; also alters pH of vagina leading to increased risk
of bacterial growth
• EMOTIONAL – “Couvade Syndrome”
• DRESSING - avoid garters, and knee high stocking that can
impede lower extremity circulation
• SEXUAL ACTIVITY - no sexual restrictions
• EXERCISE - important to prevent circulatory stasis in lower
extremities 6. Past medical history
• SLEEP 7. Gynecological history
• EMPLOYMENT 8. Ob history
• TRAVEL 9. Birthing Plan

TETANUS TOXOID IMMUNIZATION SCHEDULE FOR WOMEN FREQUENCY OF PRENATAL VISIT

• Foods to Avoid 1st and 2nd Trimester • Once a month up to 32
o Food with caffeine weeks
o Artificial sweeteners 32-36 Weeks • Twice a month (every 2
Weight loss diet weeks)
36-40 Weeks • Four times a month
COMPONENTS OF PRENATAL VISIT (every week)
1. Health history ➢ 80% of pregnant women in the Philippines should have at
2. Chief concern least 5 prenatal visits. (DOH Goal)
3. Any exposure to disease
4. Ingestion of drugs
5. Family & social profile
EMOTIONAL AND PSYCHOLOGICAL ADAPTATIONS TO PREGNANCY 3. Random Blood Sugar (RBS)
STRESSORS: 4. Blood Typing
1. Circumstances to pregnancy- couvade syndrome 5. Venereal Disease Research Laboratory (VDRL)
2. Meaning of Pregnancy to the couple 6. Hepatitis B Screening
3. Responsibilities associated with parenthood 7. Ultrasonography
4. Resources available to family
PREPARATION FOR LABOR AND DELIVERY
PSYCHOLOGICAL TASK OF PREGNANCY 1. Childbirth Education
• FIRST TRIMESTER 2. Preconception Classes
o TASK – ACCEPTING THE PREGNANCY 3. Expectant Parenting Classes
Woman and partner both spent time recovering from shock of 4. Childbirth Plan – hospital, type of delivery, etc.
learning they are pregnant and concentrate on what it feels like to 5. Childbirth Classes
be pregnant. A common reaction is ambivalence, or feeling both 6. Responsible Parenthood- contraceptives like LAM (4-6months),
pleased and not pleased at the pregnancy use of condom, knowledge on fertility (cycle, spinnbarkeit/
• SECOND TRIMESTER: mucus), etc.
o TASK – ACCEPTING THE BABY
Woman and partner move through emotions such as
narcissism and introversions as they concentrate on what it will
feel like to be a parent. Role playing and increased dreaming
are common
• THIRD TRIMESTER:
o TASK – PREPARING FOR THE BABY AND END OF
PREGNANCY
Woman and partner grow impatient with pregnancy as they ready
themselves for birth EMOTIONAL RESPONSES:
1. Self-concept related to body image
2. Mood swings related to biophysical & social changes
3. Ambivalence related to fear & anxiety
4. Sexual concerns related to biophysical changes

LABORATORY AND DIAGNOSTIC EXAMINATIONS (ACCORDING TO DOH

STANDARDS))
1. CBC
2. Urinalysis – hPL (insulin)