Professional Documents
Culture Documents
Width – 4 to 24 cm 4. OVARY
Weight – 50 to 1000g Ovulation stops (estrogen &
progesterone)
Formation of uterine muscles fibers
Amenorrhea
Stretching of existing muscle fibers
3. VAGINA
Melasma /Chloasma – “mask Pressure of the uterus:
of pregnancy”; darkened areas on the
cheeks and across the nose Slow peristalsis
Vascular spiders at thighs (estrogen) - small, Heartburn
fiery-red branching spots Constipation
Palmar erythema – redness and itchiness Flatulence
(estrogen) Hemorrhoids
Increased perspiration by the -There is weight gain
increased activity of sweat glands
Increased scalp hair growth
9. CARDIOVASCULAR SYSTEM
IMPORTANCE OF DETERMINATION OF
GESTATIONAL AGE
Clinical history
Physical examination
Ultrasound scan
Formula:
Jan- March = +9 +7
April – Dec = -3 +7 +1
LEOPOLD’S MANEUVER
Purposes:
• Number of fetuses
TAKE NOTE:
Maneuvers are the primary assessment in
determining whether the fetal lie is correctly
ascertained but the maneuvers are not truly
diagnostic.
Actual position can only be determined by
ultrasound performed by a competent
technician or professional.
3 Questions to be asked:
There are 4 distinct Leopold Maneuvers.
1. Relative consistency- the head is harder than
the breech.
Nurse Alert:
Lower pole
This maneuver determines the part of the fetus
at the inlet and its mobility.
To determine what occupies
the lower uterine
segment and to determine whether it is
engaged or not.
ENGAGEMENT: when
the biparietal diameter of the fetal head
reaches or passes the plane of the pelvic inlet.
Zero One 2 or
pregnanc pregna more
ies ncy pregnanc
beyond that has ies that
viability reached have
(20 viabilit reached
weeks) y (20 viability
weeks) (20
weeks)
WHAT IS GTPAL?
-GTPAL is very important at the initial assessment to Twins/ Triplets count as one
ensure the healthcare professional has asked for all
the crucial information about an individual’s L (Living The number of current living
reproductive history. Children) children
Twin/triplets count
individually
EXAMPLE 1: P–1
A–1
-A pregnant woman comes to the clinic for a visit. L–5
This is her third pregnancy. She had a miscarriage
at 12 weeks and gave birth to a son, now 3 years
old, at 32 weeks. Using GTPAL system, the nurse PRACTICE:
would document this women’s obstetric history as: -A 27-year-old female is currently 16 weeks
ANSWER: pregnant. She has 2-year-old twins that were born
at 39 weeks’ gestation and a 5-year-old who was
G–3 born at 40 weeks’ gestation. She had no history of
T–0 miscarriage or abortion. What is her GTPAL?
P–1 ANSWER:
A–1
L–1 G–3
T–2
P–0
EXAMPLE 2: A–0
L–3
-A nurse is collecting dictate during an admission
assessment of a client who is pregnant with twins.
the client has a healthy 5-year-old child who has
delivered at 38 weeks and tells the nurse that she
does not have a history of any type of abortion or
fetal demise. the nurse would document the
GTPAL for this client as:
ANSWER:
G–2
T–0
P–1
A–0
L–1
PRACTICE:
-A 30-year-old female is 25 weeks pregnant with
twins. She has 5 living children. Four of the 5
children were born at 39 weeks’ gestation and one
child was born at 27 weeks’ gestation. Two years
ago, she had a miscarriage at 10 weeks’ gestation.
What is her GTPAL?
ANSWER:
G–7
T–4
Fetal growth & development increases the BMR by
5% during 1st trimester and 12% during 2nd & 3rd
trimester. This increases the total energy
requirement.
2. Gastrointestinal changes:
Energy
-During first 6 months of lactation –
additional 550 kcal/d energy is required
During 6-12 months of lactation- additional
400 kcal/d energy is required
Protein
-During first 6 months of lactation- 75g of
protein is required everyday During 6-12
months of lactation – 68g of protein is
required everyday
OTHERS:
-Calcium, Iron, Folic Acid, Vitamin A & C,
Vitamin B6 & B12