NCM 107: CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENTS)

OBSTETRIC NURSING

CARE OF MOTHER AND FETUS IN THE ANTEPARTAL PERIOD

I. ESTIMATING THE DATE OF CONFINEMENT

▪ Naegele’s Rule
▪ Date of Quickening

II. CALCULATING THE AGE OF GESTATION

▪ Based on LMP and Date of Consultation

▪ McDonald’s Rule
▪ Modified McDonald’s Rule
▪ Bartholomew’s Rule

III. DETERMINING FETAL LENGTH AND WEIGHT

▪ Haases’s Rule
▪ Johnson’s Rule

IV. ASSSESSING FETAL WELL-BEING

▪ FHT Monitoring
▪ Fetal Movement (Sandovsky Method)

V. COMMON TERATOGENS AND THEIR EFFECTS

Teratogen – is any factor, chemical or physical, that adversely affects the fertilized ovum, embryo, or
fetus.

Teratogens Effects
1) Teratogenic Maternal Teratogenic maternal infections can involve either sexually
Infections transmitted or systemic infections. These organisms that cross the
placenta can be viral, bacterial, or protozoan.

▪ Toxoplasmosis, a protozoan infection, is spread most

commonly through contact with uncooked meat, although
it may also be contracted through handling cat stool in soil
or cat litter (Friars, 2007).

▪ The Rubella Virus usually causes only a mild rash and

mild systemic illness in a woman, but the teratogenic
effects on a fetus can be devastating (Johnson & Ross,
2007).

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 ▪ Cytomegalovirus (CMV), a member of the herpes virus
family, is another teratogen that can cause extensive
damage to a fetus while causing few symptoms in a
woman (Lilleri et al.,2007).

▪ Herpes Simplex Virus (Genital Herpes Infection). The

first time a woman contracts a genital herpes infection,
systemic involvement occurs. The virus spreads into the
bloodstream (viremia) and crosses the placenta to a fetus
posing substantial fetal risk (ACOG, 2007).

▪ Other Viral Diseases. It is difficult to demonstrate other

viral teratogens, but rubeola (measles), coxsackievirus,
infectious parotitis (mumps), varicella (chickenpox),
poliomyelitis, influenza, and viral hepatitis all may be
teratogenic. Parvovirus B19, the causative agent of
erythema infectiosum (also called fifth disease), a
common viral disease in school age children, if contracted
during pregnancy, can cross the placenta and attack the
red blood cells of a fetus. Infection with the virus during
early pregnancy is associated with fetal death. If the
infection occurs late in pregnancy, the infant may be born
with severe anemia and congenital heart disease
(Barankin, 2008).

2) Potentially Teratogenic Live virus vaccines, such as measles, HPV, mumps, rubella, and
Vaccines poliomyelitis (Sabin type), are contraindicated during pregnancy
because they may transmit the viral infection to a fetus (Rojas,
Wood, & Blakemore, 2007).

3) Teratogenic Drugs Many women, assuming that the rule of being cautious with drugs
during pregnancy applies only to prescription drugs, take over-the-
counter drugs or herbal supplements freely.

(Refer to Pregnancy Risk Categories of Drugs)

4) Environmental Teratogens from environmental sources can be as damaging to a
Teratogens fetus as those that are directly or deliberately ingested. Women
can be exposed through contact at home or at work sites. For
example, washing children’s hair with a shampoo such as lindane
(Kwell) to remove lice should be limited to two exposures because
of potential toxicity (Karch, 2009).

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 5) Metal and Chemical Pesticides and carbon monoxide such as from automobile exhaust
Hazards should be avoided as these are examples of chemical teratogens.
Arsenic, a byproduct of copper and lead smelting, used in
pesticides, paints, and leather processing; formaldehyde, used in
paper manufacturing; and mercury, used in the manufacture of
electrical apparatuses and found in swordfish and tuna fish, are all
teratogens that can be contacted at work sites. Lead poisoning
generally is considered a problem of young children eating lead-
based paint chips, but it also can be a fetal hazard (Maloney,
2007). Women may ingest lead by drinking water that travels
through old pipes that are leaching lead or by “sniffing” lead- based
gasoline. Lead ingestion during pregnancy may lead to a newborn
who is cognitively or neurologically challenged (Pavone &
Hueppchen, 2007).

6) Radiation Rapidly growing cells are extremely vulnerable to destruction by

radiation. That makes radiation a potent teratogen to unborn
children because of their high proportion of rapidly growing cells.

PREGNANCY RISK CATEGORIES OF DRUGS

Category Description Example

Adequate studies in pregnant women have failed to show a risk to
A the fetus in the first trimester of pregnancy; there is no evidence of Thyroid Hormone
risk in later trimesters.
Animal studies have not shown an adverse effect on the fetus, but
B Insulin
there are no adequate clinical studies in pregnant women.
Animal studies have shown an adverse effect on the fetus, but there
Docusate Sodium
C are no adequate studies on humans, or there are no adequate
(Colace)
studies in animals or humans. Pregnancy risk is unknown.
There is evidence of risk to the human fetus, but the potential
D benefits of use in pregnant women may be acceptable despite Lithium Citrate
potential risks.
Studies in animals or humans show fetal abnormalities, or adverse
Isotretinoin
X reaction reports indicate evidence of fetal risk. The risks involved
(Acutane)
clearly outweigh potential benefits.
Source: Karch, A. M. (2009). Lippincott’s Nursing Drug Guide. Philadelphia: Lippincott Williams & Wilkins

EFFECTS OF TERATOGENS ON A FETUS

Several factors influence the amount of damage a teratogen can cause. The strength of the teratogen is
one of these. For example, radiation is a known teratogen. In small amounts (everyone is exposed to

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some radiation every day, such as from sun rays), it causes no damage. However, in large doses (e.g.,
the amount of radiation necessary to treat cancer of the cervix), serious fetal defects or death can occur.

VI. OBSTETRIC AND GYNECOLOGIC HISTORY

OBSTETRIC SCORING (GP – TPALM)

GRAVIDA – number of pregnancies

PARA – the number of pregnancies that reached viability or the number of pregnancies that
reached 20 weeks or more; number of fetuses delivered with birthweight of 500 grams or more.
TERM – born between 37-42 weeks/ number of full-term infants born after 37 weeks
PRETERM – represents preterm deliveries, born 20 weeks but less than or before 37 weeks
ABORTION – represents abortion, elective or spontaneous loss of pregnancy before the period
of viability
LIVING – represents the number of living children
MULTIPLE GESTATIONS – represents the number of multiple gestations and births (not the
number of neonates delivered)

Note:

GENERAL RULE GP – TPALM SCORING: multiple gestation (twins, triplets, etc.) is counted as one in
the number of pregnancy (G) and is counted as one in the number of viable pregnancy (P).

NURSING ASSESSMENT THROUGH INTERVIEW

1) Medical and Surgical History

2) Medications and Allergies
3) Family History – medical illnesses, hereditary illnesses, multiple gestations
4) Social History – use of cigarettes, alcohol and illicit drugs
5) Review of Systems – abdominal pain, constipation, headaches, vaginal bleeding, dysuria, urinary
frequency, or hemorrhoids
6) Current Pregnancy History
a) Alcohol and Cigarette Use
b) Illicit Drug Use
c) Exposure to Radiation
d) Vaginal Bleeding
e) Nausea and Vomiting
f) Weight Loss
g) Infection
h) Exposures

INITIAL PRENATAL ASSESSMENT OF PAST OBSTETRICAL HISTORY

1) Date of Delivery
2) Gestational Age at Delivery

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 3) Location of Delivery
4) Sex of the Child
5) Birth Weight
6) Mode of Delivery
7) Type of Anesthesia
8) Length of Labor
9) Outcomes of Pregnancy – abortion, stillbirth, ectopic, etc.
10) Details of Delivery – type of CS scar, forceps, etc.
11) Maternal and Fetal Complications

PRENATAL VISIT

According to the Department of Health, prenatal check-ups should be done to the nearest health care
facility as follows:

✓ First Prenatal Visit: as early as possible, before 4 months or during the first trimester
✓ Second Prenatal Visit: during the second trimester
✓ Third Prenatal Visit: during the third trimester
✓ Every Two Weeks: after 8 months of pregnancy until delivery

TETANUS IMMUNIZATION

- This prevents tetanus neonatorum (tetanus prophylaxis).

- It is given intramuscularly (IM); 0.5 mL per dose.

Percentage of Duration of
Vaccine Interval
Protection Protection
Tetanus Toxoid (TT) 1
Tetanus Toxoid (TT) 2
Tetanus Toxoid (TT) 3
Tetanus Toxoid (TT) 4
Tetanus Toxoid (TT) 5

VII. NORMAL CHANGES IN PREGNANCY

PHYSIOLOGIC SIGNS OF PREGNANCY

Presumptive Probable Positive

▪ Fatigue ▪ Goodell’s Sign ▪ Fetal Outline evidence
▪ Frequency Urination ▪ Chadwick’s Sign by UTZ
▪ Uterine Enlargement ▪ Hegar’s Sign ▪ Fetal Heart Tone
▪ Breast Changes ▪ Positive HCG or ▪ Fetal Movement felt by
▪ Quickening positive pregnancy test Examiner
▪ Linea Nigra ▪ Ballottement
▪ Amenorrhea ▪ Braxton Hicks
▪ Morning Sickness Contraction

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 ▪ Melasma (Chloasma) ▪ Fetal parts palpable by
▪ Striae Gravidarum examiner

COMMON DISCOMFORTS IN PREGNANCY

Hormonal changes are the main cause for pregnancy discomforts.

COMMON DISCOMFORTS ETIOLOGY

1) Breast Swelling and Pain It is as a result of increasing breast size and milk
ducts expanding.
2) Fatigue It is often a result of the growing baby’s energy
requirements. In some cases, fatigue is due
to anemia (low blood iron), which is common
during pregnancy.
3) Hemorrhoids It is because of the pressure on the rectum from
the growing baby combines with an increased
blood volume.
4) Constipation It is due to the growing baby putting pressure on
the intestines, and increased iron intake
from prenatal vitamins.
5) Stomach Contents Reflux The growing baby and expanding uterus put
pressure on the stomach and intestines.
6) Varicosities (in the legs and around This may be caused by increased pressure on the
vaginal opening) legs and the pelvic veins and increased blood
volume.
7) Swelling / Bloating / Fluid Retention It is caused by pressure from the growing uterus
on the blood vessels carrying blood from the lower
body.
8) Frequent Urination (in later pregnancy) It is caused by pressure from the growing baby on
the bladder.
9) Abdominal Pain (round ligament pain) It may be due to stretching ligaments that run from
the uterus to the groin.
10) Stretch Marks These are usually as a result of rapid weight
gain during pregnancy.
11) Yeast Infections These may be a result of hormonal changes and
increased vaginal discharge during pregnancy.
12) Mood Swings It is being caused by hormones, as well
as stress and fatigue.

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 13) Backache It is a result of weight gain and the woman’s
center of gravity being pulled forward, causing
back strain.
14) Insomnia In addition to hormonal changes, insomnia during
pregnancy is also caused by increased urge to
urinate during the night, nausea, heartburn, and
difficulty finding a comfortable sleep position.
15) Dizziness During middle to late pregnancy there are several
possible causes of dizziness, including low blood
sugar, low blood pressure, low iron, dehydration,
or standing up too quickly.
16) Headaches and Migraines These can be caused by hormones, as well as
inadequate sleep, low blood sugar, low blood
pressure, and stress.
17) Gum Bleeding Increased blood flow during pregnancy may result
in gums becoming spongier which causes them to
bleed easily.
18) Pica It is a rare craving for non-food substances that
may be caused by nutritional deficiencies.

PSYCHOLOGICAL ADAPTATIONS TO PREGNANCY

First Trimester

▪ Task: Accepting the pregnancy

▪ Example: “I am pregnant.”

Second Trimester

▪ Task: Acceptance of the fetus as a separate individual.

▪ Example: “I am going to have a baby.”

Third Trimester

▪ Task: The woman prepares for the birth of the baby and her role as a mother.
▪ Example: “I am going to be a mother.”

EMOTIONAL REACTIONS EXPERIENCED BY A NEWLY PREGNANT WOMAN

1) Ambivalence – refers to simultaneous negative and positive response of the woman to

pregnancy. The negative response does not necessarily mean that the woman does not want or
rejects the pregnancy. It is usually due to the woman’s doubts about her capacity to become a
good parent to her child including doubts as to her readiness for a baby and how the baby will

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 affect her family and lifestyle. At the same time, she may also be experiencing joy and excitement
as well as happiness and anticipation.

2) Grief – a pregnant woman may experience grief as she gives up her role as a childless individual
and assumes the new role of a mother or the additional responsibilities related to the forthcoming
new member of the family.

3) Narcissism – self-centeredness is common among many pregnant women particularly in the

first month of pregnancy.

4) Fear and Anxiety – is related to the woman’s concern about her own health and the health of
her baby.

5) Uncertainty – some women may still doubt that they are pregnant despite a positive pregnancy
test and confirmation by a doctor. It is uncommon but they will feel certainty only after they felt
quickening.

Couvade Syndrome – refers to male partner experiencing the physical symptoms of pregnancy that are
being experienced by the pregnant woman. This may arise from the male partner’s stress, anxiety and
empathy felt towards the woman. In fact, the more involved the man is towards the pregnancy of his wife,
the more likely that he will experience pregnancy signs and symptoms.

SYSTEMIC CHANGES DURING PREGNANCY

Integumentary System

▪ The stretching of the abdomen causes rupture of the small segments of the connective layer of
the skin.
▪ Striae gravidarum or pinkish to reddish marks on the sides of the abdominal wall are the result
of the rupture.
▪ Linea nigra is a narrow, brown line that runs from the symphysis pubis to the umbilicus and
separates the abdomen into right and left hemispheres.
▪ Melasma or chloasma (mask of pregnancy) refers to the darkened areas on the cheeks or the
nose that may appear during pregnancy.
▪ Telangiectasis is red, branching spots that can be seen on the thighs. It is also called as vascular
spiders.
▪ Palmar erythema also occurs because of the increase in the estrogen level of the pregnant
woman.
▪ Activity of sebaceous and sweat glands may increase.

Respiratory System

▪ A pregnant woman usually experiences stuffiness or marked congestion because of the

increasing estrogen levels.

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 ▪ Shortness of breath is also a common discomfort of pregnancy as the pregnant uterus pushes
the diaphragm upward.
▪ The total oxygen consumption of a pregnant woman increases by 20%.

Gastrointestinal System

▪ Nausea and vomiting, especially in the morning, are common during the first trimester.
▪ Gum tissue may become soft and bleed when the teeth are brushed.
▪ Secretion of saliva may increase.
▪ Slower intestinal peristalsis occurs during the second trimester of the pregnancy which causes
heartburn, flatulence, and constipation.
▪ Hemorrhoids also occur from the increased pressure of the uterus on the veins in the lower
extremities

Urinary System

▪ The total body water of a pregnant woman increases up to 7.5 L for a more effective placental
exchange.
▪ Even when the woman has an increased urine output, her potassium levels are still adequate
due to progesterone, which is potassium-sparing; urine specific gravity decreases.
▪ The bladder capacity increases to accommodate 1,500 mL of urine during pregnancy.
▪ On the first trimester, the frequency of urination already increases. By the last two weeks of
pregnancy, it reaches up to 10 to 12 times per day.
▪ Urinary stasis and urinary tract infections may occur as a result of pressure on the ureter and
urethra from the growing uterus.
▪ There is an increased risk of glycosuria because reabsorption of glucose by the renal tubules
occurs at a fixed rate. During pregnancy, there is an increased glomerular filtration rate (GFR),
which leads to increased filtration of glucose into the tubules. This creates an opportunity for
spillage of glucose into the urine.

Skeletal System

▪ By the 32nd week of pregnancy, the symphysis pubis widens for 3 to 4 mm.
▪ The center of gravity of a pregnant woman change, and to make up for it she tends to stand
straighter and taller than usual and with the abdomen forward and the shoulders thrown back,
the ‘pride of pregnancy’ or commonly ‘lordosis’ occurs.
▪ Sacroiliac, sacrococcygeal, and pubic joints relax during pregnancy.
▪ The symphysis pubis may separate slightly.

Endocrine System

▪ A slight enlargement in the thyroid and parathyroid gland increases the basal metabolic rate of a
pregnant woman and for better consumption of calcium and vitamin D.
▪ Thyroid hormone production increases.

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 ▪ The insulin produced from the pancreas decreases early in the pregnancy, thereby increasing
glucose available for the fetus.
▪ Increase in insulin occurs in the first trimester because estrogen, progesterone and HPL have
insulin antagonistic properties.
▪ FSH and LH decreases causing anovulation.
▪ As the breasts are prepared for lactation, prolactin increases in production.
▪ The increase in melanocyte-stimulating hormones causes increase in skin pigment.
▪ The human growth hormone increases to aid the fetus in growing.
▪ Estrogen and progesterone aids in uterine and breast enlargement.
▪ Human placental lactogen increases glucose levels to supplement the growing fetus.
▪ Relaxin increases to soften the cervix and collagen of joints.

Cardiovascular System

▪ The heart is displaced upward, to the left, and forward.

▪ As the uterus enlarges, pressure on blood vessels increases and slows circulation. This process
can lead to edema and varicosities of the legs, vulva, and rectum.
▪ The pressure of the enlarged uterus on the vena cava causes supine hypotensive syndrome
during the second trimester (when the woman lies supine).
▪ Pulse rate and cardiac rate increases 10 to 15 beats per minute.
▪ Blood pressure decreases slightly, then returns to pre-pregnant level during the third trimester.
▪ Cardiac output increases by 25% to 50%.

VIII. DANGER SIGNS OF PREGNANCY

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IX. LEOPOLD’S MANEUVERS

DEMONSTRATION

✓ [Link]
✓ [Link]

X. DIAGNOSTIC AND LABORATORY PROCEDURES

PREGNANCY TEST

- It checks the urine or blood for the presence of human chorionic gonadotropin (hCG).
- Human chorionic gonadotropin is being produced after a fertilized egg attaches to the wall of the
uterus. This usually happens about 6 days after fertilization. Levels of hCG rise quickly, doubling
every 2 to 3 days.

▪ Types of Pregnancy Test:

1) Blood Test – it can detect pregnancy earlier than a home pregnancy test (urine), about
6 to 8 days after ovulation. It takes longer to get the results than a home pregnancy test.

Qualitative hCG Test Quantitative hCG Test (Beta hCG)

▪ It checks for hCG. It gives a "yes" ▪ It measures the exact amount of
or "no" answer to the question, hCG in your blood.
"are you pregnant?" ▪ It can find even very low levels of
▪ Doctors often order these tests to hCG. These tests may help track
confirm pregnancy as early as 10 problems during pregnancy.
days after conception. Some can ▪ Doctor may use this along with
detect hCG much earlier. other tests to rule out an ectopic
pregnancy, when the fertilized
egg implants outside your uterus,
or after a miscarriage, when hCG
levels fall quickly.

2) Urine – this is more convenient, quick and easy to use because it can be done at home.

Procedure:
✓ Hold the test stick in your urine stream.
✓ Collect urine in a cup and dip the test stick into it.
✓ Collect urine in a cup and use a dropper to put it into another container.

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 ✓ Wait for a few minutes before seeing the results.

Interpretation:

Single Line – NEGATIVE

Double Line – POSITIVE

ULTRASOUND (SONOGRAM)
- It is a prenatal test offered to most pregnant women. It uses sound waves to show a picture of
the baby in the uterus (womb). It helps the health care provider check on the baby's health and
development.
- It also:
1) Diagnose pregnancy as early as 6 weeks’ gestation;
2) Confirm the presence, size and location of the placenta and amniotic fluid;
3) Establish that the fetus is growing and has no gross abnormalities;
4) Determine sex;
5) Establish the presentation and position of fetus;
6) Predict maturity by measurement of biparietal diameter of head.

XI. PRENATAL EXERCISES AND CHILDBIRTH EDUCATION CLASSES

Taylor Sitting

Place one leg in front of the other –

should not put one ankle on top of the
other.
Gently push on her knees toward the
floor until she feels her perineum
stretch.
Can be done at least 15 minutes per
day.

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Squatting

Uses:
✓ It is used to strengthen the perineal
muscles
✓ Increases circulation to perineum.

Keep the woman’s feet flat on the floor

– for pelvic muscle to stretch.
It can be done 15 minutes/day.

Abdominal Muscle Contraction

Uses:
✓ Prevent constipation
✓ Restore abdominal tone after
pregnancy
✓ Contribute to effective second stage
pushing

Tighten the abdominal muscles then

relax. Repeat as often as you wish; or
Blowing out a candle. Take a deep
inspiration then exhales normally, then
exhale forcible, pushing out residual air
from the lungs.
Pelvic Rocking or Tilt

Use
✓ It relieves backache by making spine
more flexible.

It can be done at the end of the day,

five times to make herself more
comfortable for the night.

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 Kegel Exercise

Uses:
✓ Strengthens the pubococcygeal
muscles
✓ Increases sexual enjoyment because of
tightened vaginal muscles
✓ Strengthens urinary control and
preventing stress incontinence

Squeeze the muscles surrounding the

vagina as if stopping the flow of urine.
Hold for three (3) seconds then relax.
Repeat 10-25 minutes.
It can be done three times a day.

XII. FETAL CIRCULATION

Reading Assignment!!! Read about fetal circulation. Compare it with the normal adult circulation.

Fetal Circulation Video Illustration

[Link]

[Link]

XIII. MILESTONES OF FETAL GROWTH AND DEVELOPMENT

End of Fourth Gestational Week

At the end of the fourth week of gestation, the human embryo is a group of rapidly growing cells but does
not yet resemble a human being.

▪ Length: 0.75 – 1 cm
▪ Weight: 400 mg

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 ▪ The spinal cord is formed and fused at the midpoint.
▪ Lateral wings that will form the body are folded forward to fuse at the midline.
▪ The head folds forward and becomes prominent, representing about one-third of the entire
structure.
▪ The back is bent so that the head almost touches the tip of the tail.
▪ The rudimentary heart appears as a prominent bulge on the anterior surface.
▪ Arms and legs are budlike structures.
▪ Rudimentary eyes, ears, and nose are discernible.

End of Eighth Gestational Week

▪ Length: 2.5 cm (1 in)

▪ Weight: 20 grams
▪ Organogenesis is complete.
▪ The heart, with a septum and valves, is beating rhythmically.
▪ Facial features are definitely discernible.
▪ Arms and legs have developed.
▪ External genitalia are forming, but sex is not yet distinguishable by simple observation.
▪ The primitive tail is regressing.
▪ The abdomen bulges forward because the fetal intestine is growing so rapidly.
▪ An ultrasound shows a gestational sac, diagnostic of pregnancy.

End of Twelfth Gestational Week (First Trimester)

▪ Length: 7 – 8 cm
▪ Weight: 45 grams
▪ Nail beds are forming on fingers and toes.
▪ Spontaneous movements are possible, although they are usually too faint to be felt by the
mother.
▪ Some reflexes, such as the Babinski reflex, are present.
▪ Bone ossification centers begin to form.
▪ Tooth buds are present.
▪ Sex is distinguishable by outward appearance.
▪ Urine secretion begins but may not yet be evident in amniotic fluid.
▪ The heartbeat is audible through Doppler technology.

End of Sixteenth Gestational Week

▪ Length: 10 – 17 cm
▪ Weight: 55 – 120 grams
▪ Fetal heart sounds are audible by an ordinary stethoscope.
▪ Lanugo is well formed.
▪ Liver and pancreas are functioning.

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 ▪ Fetus actively swallows amniotic fluid, demonstrating an intact but uncoordinated swallowing
reflex; urine is present in amniotic fluid.
▪ Sex can be determined by ultrasound.

End of Twentieth Gestational Week

▪ Length: 25 cm
▪ Weight: 223 grams
▪ Spontaneous fetal movements can be sensed by the mother.
▪ Antibody production is possible.
▪ The hair forms on the head, extending to include eyebrows.
▪ Meconium is present in the upper intestine.
▪ Brown fat, a special fat that will aid in temperature regulation at birth, begins to be formed behind
the kidneys, sternum, and posterior neck.
▪ Vernix caseosa begins to form and cover the skin.
▪ Passive antibody transfer from mother to fetus begins.
▪ Definite sleeping and activity patterns are distinguishable (the fetus has developed biorhythms
that will guide sleep / wake patterns throughout life).

End of Twenty – Fourth Gestational Week (Second Trimester)

▪ Length: 28–36 cm
▪ Weight: 550 grams
▪ Meconium is present as far as the rectum.
▪ Active production of lung surfactant begins.
▪ Eyebrows and eyelashes become well defined.
▪ Eyelids, previously fused since the 12th week, now open.
▪ Pupils are capable of reacting to light.
▪ When fetuses reach 24 weeks, or 601 grams, they have achieved a practical low-end age of
viability (earliest age at which fetuses could survive if born at that time), if they are cared for after
birth in a modern intensive care facility.
▪ Hearing can be demonstrated by response to sudden sound.

End of Twenty – Eighth Gestational Week

▪ Length: 35 – 38 cm
▪ Weight: 1200 grams
▪ Lung alveoli begin to mature, and surfactant can be demonstrated in amniotic fluid.
▪ Testes begin to descend into the scrotal sac from the lower abdominal cavity.
▪ The blood vessels of the retina are formed but thin and extremely susceptible to damage from
high oxygen concentrations (an important consideration when caring for preterm infants who
need oxygen).

End of Thirty – Second Gestational Week

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 ▪ Length: 38–43 cm
▪ Weight: 1600 grams
▪ Subcutaneous fat begins to be deposited (the former stringy, “little old man” appearance is lost).
▪ Fetus responds by movement to sounds outside the mother’s body.
▪ Active Moro reflex is present.
▪ Iron stores, which provide iron for the time during which the neonate will ingest only milk after
birth, are beginning to be developed.
▪ Fingernails grow to reach the end of fingertips.

End of Thirty – Sixth Gestational Week

▪ Length: 42–48 cm
▪ Weight: 1800–2700 grams (5 – 6 pounds)
▪ Body stores of glycogen, iron, carbohydrate, and calcium are deposited.
▪ Additional amounts of subcutaneous fat are deposited.
▪ Sole of the foot has only one or two crisscross creases, compared with the full crisscross pattern
that will be evident at term.
▪ Amount of lanugo begins to diminish.
▪ Most babies turn into a vertex (head down) presentation during this month.

End of Fortieth Gestational Week (Third Trimester)

▪ Length: 48 – 52 cm (crown to rump, 35 – 37 cm)

▪ Weight: 3000 g (7 – 7.5 pounds)
▪ Fetus kicks actively, hard enough to cause the mother considerable discomfort.
▪ Fetal hemoglobin begins its conversion to adult hemoglobin. The conversion is so rapid that, at
birth, about 20% of hemoglobin will be adult in character.
▪ Vernix caseosa is fully formed.
▪ Fingernails extend over the fingertips.
▪ Creases on the soles of the feet cover at least two thirds of the surface.

*****

Prepared by:

ARIEL JAMES C. CABULAGAN, RN, MAN

Professor

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