TOPIC OUTLINE Naegele’s Rule

1. Get the LMP (last menstrual period)

I. 2. Subtract 3 calendar months
3. Add 7 days to the LMP
4. Add 1 year

Ex. LMP= 08/ 15/ 2020

-03
05/ 15/ 2020
+ 07 + 01
05/ 22/ 2021

EDC is May 22, 2021

CONTENT Facts about the Naegele’s Rule:

• Bases calculation on the woman with 28- day
cycle (most women vary)
• The typical gestation is 280 days (40 weeks)
• First time mothers usually have a slightly
longer gestation period

Mittendorf- Williams' Rule

For Caucasian women (encompasses European
people), there are different method of EDC given
that it is primigravida or multigravida:

I. ESTIMATING THE ESTIMATED DATE OF ✓ For Primigravida (first time pregnancy)

CONFINEMENT (EDC) ➢ Get the LMP
➢ Subtract 3 calendar months
Calculating the Due Date ➢ Add 15 days

• Also called estimated date of delivery (EDD) ✓ For Multigravida (two or more
• The date that spontaneous onset of labor is pregnancies)
expected to occur or the process of determining ➢ Get the LMP
the estimated time of the birth of the baby. ➢ Subtract 3 calendar months
• Typically, pregnancy lasts, on average, of 280 ➢ Add 10 days
days, or 40 weeks—starting with the first day of
the last normal menstrual period as day 1.
• An estimated due date can be calculated by
following steps of Naegele’s Rule:

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II. COMMON TERATOGENS AND THEIR
EFFECTS
What is Teratogens
• Chemicals or substances (even some
practices) that can cause birth defects or
abnormalities in a developing embryo or fetus
upon exposure of the mother while pregnant.
• Approximately, 4- 5% of birth defects are
caused by exposure to teratogens.
Types of Teratogens:
1.Physical Agents
- these are exposure to medical interventions,
workplace hazards, or heat
•Ionizing radiation
The common anomalies were:
• Microcephaly (small head
circumference)
• Microphthalmia (small eyes)
Other places to avoid during pregnancy:
• Saunas
• Steam rooms
• Whirlpool
• And any other places with extreme heat
that may raise the woman’s body temp.
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2. Maternal Conditions
-number of chronic illnesses or conditions in the
mother while pregnant. Usually, the risk lies with
the drugs used for treatment, rather than the
illness itself
-these are the second category of teratogens
•Chicken Pox
The common anomaly in the first 20 weeks of
pregnancy is:
• Congenital varicella syndrome
-risk of developing skin scars,
abnormalities of the eyes, legs, arms,
and brain, as well as gastrointestinal
problems
The common anomaly around the time of the
delivery of the baby is:
• Neonatal varicella
-can result in severe or fatal illness of the
newborn within a few days of delivery
•Thyroid Disorders
The common anomalies were:
• Miscarriage
• Premature separation of the placenta
from the uterine wall (placental
abruption)
• Preterm labor
• Lower IQ scores in the children
•Diabetes
For hypoglycemia (low blood sugar), the
common anomaly is:
• Fetal malformation
For hyperglycemia (high blood sugar), the
common anomalies are:
• Neural tube defects (birth defects of the
brain and spinal cord)
• Induced release of free radicals
(damaged cells that are missing an
essential molecule) which disrupt fetal
development
•Malnutrition
The common anomaly is:
• Fetal lacks essential nutrients for proper
development
3. Infection •Cytomegalovirus
-viral infections in pregnancy are major causes -spread through sexual and nonsexual contact
of maternal and fetal morbidity and mortality with body secretions
The common anomalies are:
-infections can develop in the neonate • Pregnancy loss
transplacentally, perinatally (from vaginal • Preterm birth
secretions or blood), or postnatally (from breast • Low birth weight
milk or other sources) • Hearing loss

•Rubella virus •Parvovirus B19

-also known as German Measles -also called the fifth disease
The common anomaly is: -the infection is mostly asymptomatic, but in
• Congenital malformation approximately 3% of infected women it might
cause a range of complications
•Herpes simplex virus The common anomalies are:
The common anomaly is: • Stillbirth
• Congenital abnormalities • Miscarriage
• • Fetal anemia
•Syphilis • Non-immune fetal hydrops
-bacterial infection usually spread by sexual • Fetal demise
contact
The common anomalies are:
• Stillbirth
• Transmittable to babies (congenital
syphilis) that later cause:
-bone damage
-severe anemia
-enlarged liver and spleen
-jaundice
-nerve problems causing blindness or
deafness
-meningitis
-skin rashes

•Toxoplasmosis
-infection caused by cat feces
The common anomalies are:
• Miscarriage
• Stillbirth
• Birth defects (congenital toxoplasmosis
that caused):
-vision loss
-seizures
-hearing loss
-microcephaly (very small head and
brain)
-hydrocephalus (too much fluid in the
brain)
-developmental delays

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4. Drugs and Chemicals
-certain drugs and chemicals are known to
cause birth defects if taken during pregnancy
•Alcohol
-commonly used teratogens
The common anomalies are:
• Miscarriage
• Stillbirth
• FASDs or Fetal Alcohol Spectrum
Disorders that could cause:
-physical, behavioral, and intellectual
disabilities
•Cocaine
The common anomalies are:
• Behavioral problems
• Impaired language development
• Adverse cognitive
• Neurodevelopmental issues
•BPA or Bisphenol A
-a chemical mainly found in plastics that are
used as storage of food and beverage
The common anomalies are:
• Risk of miscarriage
• Defects of a testicular hormone in
newborn boys with undescended
testicles
Other Teratogenic Drugs:
• ACE (angiotensin converting enzyme)
inhibitors
• Angiotensin II antagonist
• Isotretinoin (an acne drug)
• High doses of vitamin A
• Lithium
• Male hormones
• Some antibiotics
• Some anticonvulsant medications
• Some cancer-fighting medications
• Some drugs that treat certain rheumatic
conditions
• Some thyroid medications
• Thalidomide
• The blood-thinning drug warfarin
• The hormone diethylstilbestrol (DES).
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III. HEALTH HISTORY
Health history in pregnancy is all about learning
both parents' health history as the foundation to
make the pregnancy and birth as safe as possible.
It addresses potential conditions including:
• Birth defect
• Developmental disability
• Newborn screening disorder
• Genetic disease
Health History Components
1. Biographical Data
2. Chief Complaints
- Aside from the scheduled doctor
visits of mothers, some come to
health care providers to seek
information or reassurance about
certain concerns
3. Family Profile
- Including the mother and her
partner’s age, occupation,
educational attainment, marital
status, available support system,
etc.
4. History of Past Illness
- Includes hereditary diseases,
infectious diseases, immunization,
allergies, past surgeries and
hospitalizations
5. History of Family Illness
- Includes the health of intermediate
family for detection of genetic
disorders to the mother and fetus.
6. Social Profile
- Includes nutrition/ elimination, rest/
exercise, recreation, interactions,
and medications
7. Gynecologic History
- Includes the assessment of female
reproductive system
8. Obstetric History
- Includes the questions about current
and/or previous pregnancy
- GTPAL
9. Review of Systems
- List of questions, arranged by organ
system, designed to uncover
dysfunction and disease within certain
area, if there is.
The doctor might also require genetic
counseling.
Genetic Counseling
-interpretation of the results of genetic tests
(like blood tests) that helps to make decisions
about the pregnancy and how to best care for
the child.
-“Genetic counseling services can determine
if your child is at risk for genetic disorders and
provide support along the way and help you
prepare for the birth of a child with special
needs.” (W. Andrew Faucett)
Other reasons for Genetic Counseling
include:
• Infertility (trouble getting pregnant)
• 2 or more miscarriages
• A previous pregnancy or child with a
genetic disease or birth defect
• A baby who died at less than 1 year of
age
Test results can be negative (you do not have the
gene) or positive (you do have the gene)
Most carrier screening is for recessive disorders:
•Recessive Disorders
- The disorder/s that inherited of the child
from the parents who were both the
carriers of the recessive genes.
- In most cases, if both parents have the
recessive genes, there is a 25% chance
that the child could unfortunately inherit the
disorder or instead, 50% chance of making
him/her a carrier.
•Carrier
- The person that has only one gene of
certain disorder
- If only one parent has the recessive gene,
there is a 50% chance that the child is a
carrier too.
When to have Carrier Screening:
- Some people decide to have carrier
screening before having children. Getting
tested before pregnancy gives you a
greater range of options and more time to
make decisions.
- Carrier screening also can be done during
pregnancy

For genetic counseling to happen, genetic

testing is required. This includes:

•Carrier Screening
-Type of genetic test that can tell you whether
the parent/s carry a gene for certain genetic
disorders.
-When it is done before or during pregnancy,
it allows you to find out your chances of
having a child with a genetic disorder.

Carrier screening involves testing a sample

of:
• Blood
• Saliva
• Tissue from the inside of the cheek

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IV. NORMAL CHANGES DURING
PREGNANCY
Pregnancy brings a variety of changes to the
body. They can range from common and
expected changes, such as swelling and fluid
retention, to less familiar ones such as vision
changes
Pregnancy changes may include:
• Backache
• Nausea and vomiting
• Constipation
• Heartburn
• Hemorrhoids
• Frequent urination
Third Trimester:
• Feeling tired
• Increase in appetite
• Increased vaginal discharge
• Tender breasts
Pregnancy stages
Some physical and emotional experiences are
more common in each of these trimesters:
First Trimester:
• You feel really tired and possibly
nauseous.
• You gain 1 or 2 kilograms, or maybe
less if you have morning sickness. Most
of this weight is in the placenta, your
breasts, your uterus and extra blood.
• Your heartbeat and breathing rate are
faster.
During pregnancy, the mother tends to feel
• Your breasts become tender, larger and
different emotions due to hormonal changes.
heavier.
Some of it are:
• Your growing uterus puts pressure on
your bladder, so you feel like you need
to urinate a lot.
• You may feel swinging moods.
• You know exactly how you feel about
having a baby, or you have no idea how
to feel
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Second Trimester:
• You start to feel better, with less fatigue,
morning sickness and moodiness.
• You may feel your mind is wandering and
not focused at work or at home.
• You gain about 6 kilograms.
• You may feel anxious about tests done at
this stage. But, if they find any health
issues, these tests will ensure you and your
baby receive the right care.
• Your hair may become thicker and your
fingernails may become stronger. Or, your
nails may be softer and break more easily.
• You may crave some foods, such as sweet,
spicy or fatty foods.
• You may not like the taste or smell of some
foods.
• Forgetfulness may continue.
• You feel tired and probably uncomfortable.
• You may be annoyed by the discomfort.
• You may start to worry about labour as it
nears.
• You probably gain about five kilograms.
Much of this weight is your baby, but also
amniotic fluid, the placenta, your breasts,
your blood and your uterus.
• You may have back pain.
• You may find it hard to sleep because you
are uncomfortable.
• The baby may be placing pressure on your
lungs, making it harder to breathe.
• You may feel Braxton Hicks contractions
(tightening of the muscles of the uterus).
But they do not mean labour is starting.
• Mood swings
-heightened emotions, both positive and
negative.
• Depression and Anxiety
-About 15 percent of women will have
depression or anxiety during pregnancy.
This may be by feeling quite anxious
about the pregnancy and about being a
parent. Seek consultation if it gets out of
your control.
V. DANGER SIGNS OF PREGNANCY

• Sudden gush of fluid from the vagina

• Vaginal bleeding
• Convulsions/fits
• Severe headaches with blurred vision
• Fever and too weak to get out of bed
• Severe abdominal pain
• Persistent vomiting
• Fast or difficult breathing
• Swelling of fingers, face and legs
• Chills with fever over 38° C
• Painful urination or reduce urine output

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 Practice Test
Match the column A with column B by writing the designated letter for every
answer in the space provided.

A B

1. The person that has only one gene of certain a) Alcohol

disorder
2. The date that spontaneous onset of labor is b) Obstetric History
expected to occur or the process of
determining the estimated time of the birth of c) Recessive
the baby Disorders
3. Includes the assessment of female
reproductive system d) Infection
4. Includes the questions about current and/or
previous pregnancy e) Carrier Screening
5. Type of teratogens that could develop in the
neonate transplacentally, perinatally (from f) Carrier
vaginal secretions or blood), or postnatally
(from breast milk or other sources) that might g) Ionizing radiation
pass to the fetus/ baby
6. Chemicals or substances that caused h) Gynecologic History
approximately 4- 5% of birth defects
7. An example of teratogens that could caused i) EDC
microcephaly and microphthalmia to the baby
8. Heightened emotions, both positive and j) Teratogens
negative during pregnancy
9. Genetic test that can tell you whether the k) Mood swings
parent/s carry a gene for certain genetic
disorders.
10. The disorders that inherited of the child from
the parents who were both the carriers of the
recessive genes

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 Answer Key

1. F

2. I

3. H

4. B

5. D

6. J

7. G

8. K

9. E

10. C

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