By

Mrs/ Hamdia Mohammed

Learning Objectives:

1- Identify the items of

preconception assessment.
2- List the assessment elements
during pregnancy.
3- Discuss how to diagnose the
pregnancy.
4- Perform Leopold maneuver for
pregnant woman.
5- List five abnormalities when
 Preconception assessment
Preconception assessment
including:
Nutritional intake (e.g., sufficient
intake of folic acid).
Life style (e.g., drinking and
smoking habits).
Womans health status.
Identify any potential problems
(e.g., ectopic pregnancy).
Identify the womans
understanding and expectations of
Assessment elements during
pregnancy
Assessment elements during
pregnancy including:
Womans health status.
Nutritional status as well as the well-
being of the fetus is important
throughout pregnancy.
Assess the womans physiologic
adaptation and the familys
psychological adaptation to pregnancy.
Noting any abnormal findings.
Physical findings are gained though
 Assessment
childbearing client
Diagnosis of the pregnancy:
Rapid serum pregnancy test.

Presumptive, probable and

positive signs of pregnancy.

Laboratory tests.
 Presumptive, probable and positive
signs of pregnancy
Time Presumpt Probable Description
from ive finding
implantat finding
ion
(weeks)
1 Serum Tests of blood
laborato serum reveal the
ry tests presence of human
chorionic
gonadotropin
hormone
2 Breast Feeling of
changes tenderness,
fullness, or
tingling;
Presumptive, probable and
positive signs of pregnancy
 Signs and symptoms of
pregnancy are divided into
three:
1. Presumptive signs (least predictive
of pregnancy), subjective and cannot
be assessed by examiner.
2. Probable signs ( can be
documented by examiner).
3. Positive signs are those which
cannot be mistaken for any other
condition -- they are considered
absolute evidence of pregnancy.
 Presumptive, probable and
positive signs of pregnancy
Time from Presumpt Probable Description
implantatio ive finding
n (weeks) finding
2 Amenorrh Absence of
ea menstruati
on
3 Frequent Sense of
urination having to
void
frequently
6 Chadwicks Color
sign change of
the vagina
from pink
 Presumptive, probable and
positive signs of pregnancy
Time from Presump Probable Description
implantati tive finding
on finding
(weeks)
6 Goodells Softening of the
sign cervix
6 Hegars Softening of the
sign lower uterine
segment
6 Sonogra Characteristic
phic ring is evident.
evidence
of
 Presumptive, probable and
positive signs of pregnancy
Time Presump Proba **Positiv Descript
from tive ble e finding ion
implantat finding findin
ion g
(weeks)
8 Sonograp Fetal
hic outline
evidence can be
of fetal seen
outline and
measure
d by
sonogra
m
 Presumptive, probable and
positive signs of pregnancy
Time from Presumpti Probable **Positi Description
implantati ve finding finding ve
on (weeks) finding
12 Fatigue General feeling of
tiredness
12 Uterine Uterus can be
enlargem palpated over
ent symphysis pubis
16 Ballottem When lower
ent uterine segment is
tapped on a
bimanual
examination, the
fetus can be felt to
rise against
abdominal wall
 Presumptive, probable and positive
signs of pregnancy
Time Presumpti Probabl **Positi Descriptio
from ve finding e ve n
implantat finding finding
ion
(weeks)
18 Quickening Fetal
movement
felt by
woman
20 Fetal Fetal
movement movement
felt by can be
examiner
palpated
through
abdomen
 Presumptive, probable and
positive signs of pregnancy
Time from Presumpt Probabl **Positi Descriptio
implantati ive e ve n
on finding finding finding
(weeks)
24 Linea Line of
nigra dark
pigment
on the
abdomen
24 Melasma Dark
pigment
on face.
24 Striae Red
 Assessment childbearing
woman
Laboratory tests:

Detecting the presence of human chorionic

gonadotropin (HCG) in the
Urine
blood

HCG appear in the serum as early as 24-48 hours after

implantation.
 Leopolds Maneuver

Four-part process
1. Determine the position of the baby in
utero
2. Determine the expected presentation
during labor and delivery
 Preparation
Woman is supine, head slightly
elevated and knees slightly flexed
Place a small rolled towel under her
right hip

If the doctor is R handed, stand at the

womans R side facing her for the first 3
steps, then turn and face her feet for
the last step (L handed, left side).
 First Maneuver
What part is in the fundus?
Facing the mother, palpate the fundus
with both hands
Assess for shape, size, consistency and
mobility
Fetal head: firm, hard, and round
Moves independently of the rest
Detectable by ballotement
Buttocks/breech: softer and has
bony prominences
Moves with the rest of the form
Fundal Palpation
 Second Maneuver
Determine position of the back.
Still facing the mother, place both palms on
the abdomen
Hold R hand still and with deep but gentle
pressure, use L hand to feel for the firm,
smooth back
Repeat using opposite hands
Once located the back, confirm findings by
palpating the fetal extremities on the
opposite side (lumpy)
Lateral Palpation
 Third Maneuver
Determine what part is lying above the inlet.

Gently grasp just above symphisis pubis

with the thumb and fingers of the R hand
Confirm presenting part (opposite of whats
in the fundus)
Head will feel firm
Buttocks will feel softer and irregular
If its not engaged, it may be gently pushed
back and forth
Proceed to the 4th step if its not
engaged
Pawliks maneuver
(gribs)
 Fourth Maneuver
Flexed/Deflexed/Extended?
Turn to face the womans feet
Move fingers of both hands gently down the
sides of the abdomen towards the pubis
Palpate for the cephalic prominence (vertex)
Prominence on the same side as the small
parts suggests that the head is flexed
(optimum)
Prominence on the same side as the back
suggests that the head is extended
Pelvic palpation
Abdominal gribs
 Pregnancy and the mouth
Hypertrophy of the gums
Increased vascularity
Changes in salivary composition
Increased plaque deposition
Exposure to stomach acids (1st
trimester)
Loosening of teeth (3rd trimester)
 The mouth

Angular
cheilitis
B vitamin
deficiency
Fungal
infections
Over-biting
Gingivitis of pregnancy
 The mouth

Mild aphthous
ulcer (AKA
canker sore)
Viral, bacterial
Stress
Underlying
immune disease
if frequent
Cyanosis of nail beds
Edema