Notes
Naegele’s Rule
It is used for estimating an expected due date
based on the woman’s last menstrual period
(LMP).
It bases it calculation that the woman has a 28
day menstrual cycle (many woman vary) AND
that it will be a gestation period of 280 days
(40 weeks)… again this varies because
gestation is slightly longer for first time
mothers. Hence, Naegele’s Rule calculation in
JUST an estimation!
Always give February 28 days (regardless of
a leap year…to keep things simple).
Know which months have 30 days vs 31 days
(September, April, June & November have 30
days)
Calculation Formula for Naegele’s Rule
LMP Date
1. Subtract 3 months from the LMP
2. Add 7 Days to the LMP
3. Add 1 Year
(use this calculation formula for patients whose
LMP falls between April-Dec)
OR
LMP Date
1. Add 7 Days to LMP
2. Then add 9 months
(use this calculation formula for patients whose
LMP falls between January-March rather than
the other formula)
McDonald's Rule
To compute AOG using LMP (last menstrual
period), follow these steps:
1. First Subtract the lmp to the number of
days the month has
2. Calculate the number of days between the
current date and the first day of the LMP.
3. Divide the total number of days by 7 to find
the AOG in weeks.
Stages of Labor
First stage of labor
~ initiation of true labor contractions and ends
when the cervix is fully dilated
~ The first stage may take about 12 hours to
complete and is divided into three phases: latent,
active, and transition
Latent phase
The latent or early phase begins with regular
uterine contractions until cervical dilatation.
Contractions during this phase are mild and short,
lasting 20 to 40 seconds. Cervical effacement
occurs, and the cervix dilates minimally.
Active phase
The active phase occurs when cervical dilatation
is at 6 to 7 cm and contractions last from 40 to
60 seconds with 3 to 5 minutes intervals. Bloody
show or increased vaginal secretions and perhaps
spontaneous rupture of membranes may occur
at this time.
Transition phase
The last phase, the transition phase, occurs when
contractions peak at 2 to 3-minute intervals and
dilatation of 8 to 10 cm. If it has not previously
occurred, the show will occur as the last mucus
plug from the cervix is released. By the end of
this phase, full dilatation (10 cm) and complete
cervical effacement have occurred.
Second stage of labor
~ starts when cervical dilatation reaches 10 cm
and ends when the baby is delivered.
~ The fetus begins the descent, and as the fetal
head touches the internal perineum to begin
internal rotation, the client’s perineum begins to
bulge and appear tense. As the fetal head pushes
against the vaginal introitus, crowning begins, and
the fetal scalp appears at the opening to the
vagina.
Third stage of labor/ Placental stage
~ begins right after the baby’s birth and ends with
the delivery of the placenta.
~ Two separate phases are involved: placental
separation and placental expulsion. Active bleeding
on the maternal surface of the placenta begins
with separation, which helps to separate the
placenta further by pushing it away from its
attachment site. Once separation has occurred,
the placenta delivers either by natural bearing
down the client’s effort or gentle pressure on
the contracted uterine fundus.
Labor Watch Monitoring
Duration
~ From the beginning of contraction to the end
of the same contraction
~ Expressed in “ seconds”
~ Maximum duration= 90 seconds
Frequency
~ From the beginning of the first contraction to
the beginning of the next contraction.
~ Expressed in “every minutes”
Interval
~ From the end of the first contraction to the
beginning of the next contraction.
~ Best time for checking maternal BP, FHT
Intensity
~ the strength of uterine contractions during
Acme
~ PALPATION - placing the hand lightly on the
fundus with the fingers spread judging the degree
of indentability of the uterine wall during Acme.
Mild
fundus is slightly tense & easy to indent with
fingertips
Feels like touching tip of nose
Moerate
fundus is firm & difficult to indent with
fingertips
Feels like touching chin
Strong
fundus is hard, firm & rigid
almost impossible to indent with fingertips
Boardlike fundus
Feels like touching finger to forehead
Dilation
~ Progressive , opening/widening of the cervical
canal
~ Expressed in centimeters (cms)
~ 10 cm = fully dilated cervix
 Effacement
~ shortening and thinning of the cervical canal
~ Expressed in percentage(%)

1st degree laceration

A tear on the fourchette, perineal skin, vaginal
mucous membrane

25% effaced
cervix is ¾ of its original length
50% effaced
cervix become ½ of its original length
75% effaced
cervix become ¼ of its original length
100% effaced
2nd degree laceration
fully effaced cervix
cervical canal become paper-thin tear on the fourchette, perineal skin, vaginal
mucous membrane, fascia and perineal
Primipara muscles
~ effacement before dilatation
Multipara
~ dilatation before effacement

Normal Blood Loss

dilatation before effacement
~ 500ml
Cesarean Section
~ 1000ml 3rd degree laceration
A tear on the fourchette, perineal skin, vaginal
Different Types of mucous membrane, fascia and perineal
muscles, perineal body, anal sphincter

Episiotomies
Midline/Median episiotomy
incision is made straight in the midline of the
perineum
Easily repaired, less discomfort
allows faster and less painful healing
DISADVANTAGE: may extend up to rectum
Mediolateral episiotomy
incision directed laterally away from the
rectum
rectal structures are avoided
cause more pain during healing
fourth degree laceration
tear on the fourchette, perineal skin, vaginal
mucous membrane, fascia and perineal
Ballard Score
muscles, perineal body, anal sphincter and
rectum

Episiotomy
surgical incision into the perineum to enlarge
the vaginal opening
to prevent tearing of the perineum and
release pressure on the fetal head with birth
done during or prior crowning
Episiorrhaphy
Repair of perineal laceration or of episiotomy
stitching together the margins of a tear in the
tissues lacerated during vaginal delivery

APGAR Score
ppearance or how the baby looks
A The Apgar scoring is done during the first 1
minute and 5 minutes of life. The heart rate,
P ulse respiratory rate, muscle tone, reflex
irritability, and color are evaluated in an infant.
Apgar score is the baseline for all future
G rimace observations.

A ctivity
R espiratory rate