Estimating EDD: Mittendorfs Rule

• An alternative to Naegel’s Rule in determining the

expected date of delivery (EDD) is Mittendorf’s
Rule (Mittendorf, Williams. Berkey & Cotter, 1990)
Procedure:
a. Determine the first day of the last menstrual
period (LMP).
b. Categorize the woman as Caucasian or non-
Caucasian (race).
c. Identify her gavidity: Primigravida(G 1) or
multigravida (G2 or above).
Estimating EDD: Mittendorfs Rule
For primigravida Caucasian women:
Formula: LMP + 15 days (constant) – 3 months =
EDD
Problem A: what is the EDD of Mrs. Smith, a G 1
(first time pregnant) Caucasian with last menstrual
period (LMP) of May 14?
M D
5 14
-3 + 15
2 29 = EDD: February 29
Estimating EDD: Mittendorfs Rule
• For multigravida non-Caucasian women:
• Formula: LMP + 10 days (constant) – 3 months =
EDD
• Problem B: what is the EDD of Mrs. Peralta, G 2
(multigravida) Filipino woman (non-Caucasian)
with LMP of August 10?
M D
8 10
-3 + 10
5 20 = EDD: May 20
• The date of pregnancy or gestational
age can be established using certain
clinical milestones.
• Early prenatal care
• Simplest method of establishing gestational age
( within 2 wks after missed menses and has
positive urine pregnancy test – indicative of
pregnacy)
• Quickening – is the first
sensation/perception of fetal movement
by the mother
• 18 and 20 weeks
• The date of pregnancy or gestational
age can be established using certain
clinical milestones.
• Auscultation of fetal heart tones(FHT)
• Ordinary unamplified stethoscope- 20 wks.
• fetoscope between 17-19wks
ESTIMATING
GESTATIONAL AGE
• Fundic Height

• Three landmarks for

fundic height detection
and estimating
gestational age:
ESTIMATING GESTATIONAL AGE
• The Department of Health (DOH) prescribes in its
Home Based Maternal Birth Record (HMBR) the
following fundic height level in the second half of
pregnancy:
• Fifth month gestation : 20 cm
• Sixth month gestation : 21-24 cm
• Seventh month gestation : 25-28 cm
• Eight month gestation : 29-30 cm
• Ninth month gestation : 30-34 cm
• Ultrasonography
• A more accurate way for confirming gestational age
Estimating Fundic Height: McDonald’s Method
Estimating Gestational Age: McDonald’s Rule
Exercise#1:
• Problem 1: what is the estimated gestational
age in months if the fundic height is 31.5cm?
• Problem 2: what is the estimated gestational
age in months if the fundic height is 21cm?

• Problem 3: what is the estimated gestational

age in weeks if the fundic height is 36cm?
• Problem 4: what is the estimated gestational
age in weeks if FH is 21 cm?
Estimating Fetal Length: Haase’s Rule
Haase’s Rule – use to estimate fetal length.
Formula:
A. From 1 to 5 lunar months, square the
month of pregnancy (to square a number
is to multiply it by itself).
• (months of pregnancy)² = fetal length
• Prob. How long is a 4-month-old fetus?
• Solution: 4x4 = 16 cm
Estimating Fetal Length: Haase’s Rule
Haase’s Rule – use to estimate fetal length.
Formula:
B. From 6-10 lunar months, multiply the
month by 5.
• (months of pregnancy) x 5 = fetal length
• Prob. How long is a 7-month-old fetus?
• Solution: 5 x 5 + 35 cm
Exercise#2:
• 1. What is the estimated length of a 3 -
month-old fetus?

• 2. what is the estimated length of a 10-

month-old fetus?
Estimating Fetal Weight: Johnson’s Rule
Johnson’s formula – is used for
estimating fetal weight (FW) in grams.
This can only be used in cephalic
vertex presentation.
• First, determine the Fundic Height
and then identify the station; a minus
(-) station is above the ischial spines
and a plus(+) station is below the
ischial spine.
• To estimate station – perform
Leopolds maneuvers (3rd ) by locating
the vertex in the lower abdomen
above the symphysis pubis, the
grasping and trying to move it.
Estimating Fetal Weight: Johnson’s Rule
• If the vertex can be moved
freely above the symphysis
pubis, the vertex is above the
ischial spine (-) station.
• If the vertex cannot be
moved, then it is below the
ischial spines (+) station.
Estimating Fetal Weight: Johnson’s
Rule
• Formula:
A. For vertex above the IS: Subtract 12 (constant)
from the fundic height, then multiply by 155
(constant).
FH – 12 X 155 = Fetal Weight in grams.
Prob. What is the estimated weight in grams of the
fetus of Mrs. Y, given the following data:
fundic height: 32cm; presentation: cephalic
vertex; station -2?
Solution: (32 cm – 12) X 155 = 3,100
Estimating Fetal Weight: Johnson’s
Rule
• Formula:
B. For vertex below the IS: subtract 11 (constant)
from the Fundic Height, then multiply by 155
(constant).
FH – 11 X 155 = Fetal Weight in grams.
Problem: What is the estimated weight in grams of
the fetus of Mrs. Z, given the following data:
fundic height: 34cm; presentation: cephalic
vertex; station +1?
Solution: (34 cm – 11) x 155 = 3,565
Exercise #3:
1. What is the estimated weight in grams of the
fetus of Mrs. Prex, given the following data:
fundic height: 28cm; presentation: cephalic
vertex; floating?
Solution: (28 cm – 12) X 155 = 2,480 grams.
B. What is the estimated weight in grams of the
fetus of Mrs. Cross, given the following data:
fundic height: 36cm; presentation: cephalic
vertex; station +3?
Solution: (36 cm – 11) X 155 = 3,875 grams.
 Preventing Common
Discomforts in Pregnancy
a. Nausea & vomiting
• found in about 60-65% of all pregnant women- most common
discomfort
• usually in the morning but may be experienced at any time during the
day
Causes: Prevention:
• Hormones of pregnancy are generally • Take dry carbohydrates (crackers, toast
acknowledged basis for morning with am or jelly) 30 mins. before getting
sickness out of bed in the morning.
• Increase in HCG is found in • other offenders, such as spicy foods and
excessive vomiting acidic citrus fruits, on an empty stomach.
• Relaxing effect of GIT by the • Take small, frequent meals.
hormones of pregnancy • Increase fluids, but best tolerated between
• Pressure on & displacement of the meals. Drinks found tolerated and
GIT result in poor digestion & a preferred by clients to help control nausea
constant feelling of fullness are peppermint tea & ginger tea.
• Decreased glycogen reserve
• Emotional factors
 Preventing Common
Discomforts in Pregnancy
b. Heartburn/ Pyrosis
Causes: Prevention:
• Poor tone of the cardiac • Take small, frequent meals.
sphincter of the stomach • Refrain from taking indigestible, fatty and spicy foods
causes easy esophageal (more irritation). However, the ingestion of a small
reflux of acidic gastric amount of fat (butter or cream) 20 mins.before eating
secretions, resulting in and at the onset of nausea may be considered, as fat
burning sensation inhibits secretion of stomach acid.
behind the sternum from • Maintain an upright position-
esophageal irritation. • Assume a 30 cm head-of-bed elevation.
• Poor digestive ability of • Bend from the knees & not from the waist when
the stomach from picking objects from the floor.
decreased hydrochloric • Take meals in an upright position and remain upright
acid and poor muscle 3 to 4 hours after.
tone • Refrain from taking gas-forming foods, such as
• Decrease peristalsis cabbage, turnips, cucumber, onions and cailiflowers.
• Antacid may be taken - to neutralize gastric acidity.
 Preventing Common
Discomforts in Pregnancy
c. Frequency of voiding
Cause
• Pressure on the bladder
by the gravid uterus in
the first & third trimesters.
• It is usually not a second
trimester discomfort, as
the uterus rises out of the
pelvic cavity and
becomes an abdominal
content in the second
trimester.
Management
• Increase fluid intake to replace
losses except before bedtime
to prevent nocturia, which can
disturbed sleep.
• Use perineal pad to absorb
leakage.
• Flush the perineum every after
voiding, as to increased sugar
in the urine of a pregnant
woman favors fungal growth.
 Preventing Common
Discomforts in Pregnancy
d. Constipation
Causes
• Pressure on bowels exerted
by the gravid uterus
• Relaxing effect of hormones
on the intestinal tract (results
in poor muscle tone)
• Decreased physical exercise
• Oral iron (assess frequency
of bowel movement if taking
iron preparation because it
is constipating).
Prevention
• Increase fluid intake (6 to 8
glasses a day)
• Increase roughage or bulk in the
diet (fruits & veg. dried fruits like
raisins & prunes are high in fiber
& are good sources of iron).
• Defecate regularly
• Regular exercise
• A mild laxative is the last resort,
but only when prescribed by the
physician.
 Preventing Common
Discomforts in Pregnancy
e. Hemorrhoids
Causes Prevention Management
a. Constipation • Avoid straining during • Avoid spicy foods for
b. Increased intr- bowel movement (to comfort
abdominal pressure prevent constipation). • Ice packs or warm
from frequent/heavy • Avoid lifting heavy water sitz bath may be
lifting objects. tried to help promote
c. Pressure on the rectal • Prolapsed hemorrhoids
region/veins by the are lubricated and may
gravid uterus be replaced gently
d. Distention of veins by • Hemorrhoidectomy is
increased blood not performed during
volume due to pregnancy.
increased estrogen ->
increased vascularity
-> hemorrhoids
 Preventing Common
Discomforts in Pregnancy
f. Leg Cramps
Causes Prevention
a. Calcium and a. Increased dietary
phosphorus intake of calcium. 4
imbalance glasses mil a day
b. Muscle fatigue provides the daliy
c. Pressure on the calcium req.of 1200mg
nerves supplying (400mg added to the
the lower extrmities non-preg 800mg daily
req.)
b. Some physicians
prescribe a small
amount of Amphogel.
c. Avoid fatigue of leg
musles: change
position frequently.
d. No constricting garters.
Management
a. Flexing the mothers
foot toward her knee to
hyper-extend the
involved muscles offers
immediate relief:
• Using one hand, push
down on the knee to
straighten the leg.
• With the other hand,
flex the foot oward
the knee
 Preventing Common
Discomforts in Pregnancy
Causes Prevention
• Primarily due to • Wear support or elastic
pressure on the pelvic stockings. They are
girdle by the gravid best worn before getting
uterus. out of bed or after
• Increased vascularity elevating the legs for
because of estrogen several minutes to drain
• Constricting garters the swollen veins. This
• Prolonged standing and is the best preventive
sitting measure. If elastic
bandages are used,
they should be applied
from the foot up, using
even tension to prevent
circulation obstruction.
 Preventing Common
Discomforts in Pregnancy
g. Leg Varicosities
Causes Prevention Management
• Primarily due to • Wear support or elastic
pressure on the pelvic stockings. They are best
girdle by the gravid worn before getting out of
uterus bed or after elevating the
• Increased vascularity legs for several minutes to
because of estrogen drain the swollen veins.
• Constricted garters (Best preventive measure)
• prolonged standing • Elevate legs and hips
and sitting frequently:
Elevate the legs against
the wall for 30 minutes
before sleep
Elevate legs and hips at
intervals during the
day/work time.
 Preventing Common
Discomforts in Pregnancy
Causes Prevention Management
• Avoid prolonged sitting
and standing
• Avoid wearing round
garters and knee-high
stockings.
 Preventing Common
Discomforts in Pregnancy
h. Supine Hypotensive Syndrome/Vena Caval
Syndrome
Causes Prevention Management
• The pressure exerted by • Gradual positional
the gravid uterus on the changes
big blood vessels on the • Left side-lying position
right side (descending in bed; the left lateral
aorta & inferior vena cava) recumbent (LLR) is the
impedes venous return. best position for
The reduced venous pregnant women in
return results in reduced third trimester of
cardiac output causing pregnancy & labor.
;hypotension & leading to • Gradual rising from
feelings of light bed in the morning on
headedness, dizziness the left side
and faintness.
 Preventing Common
Discomforts in Pregnancy
i. Pedal Edema/Swelling of the legs
Causes Prevention Management
• Pressure on the pelvic • Avoid prolonged sitting
girdle and standing
• Prolonged standing or If the job required
sitting prolonged sitting, stand
• Constricting garters & walk about at intervals
 If the job required
prolonged standing, sit
& elevate legs at
intervals
• Wear comfortable shoes;
avoid round garters
• Elevate legs against the
wall for 30 minutes at night
 Preventing Common
Discomforts in Pregnancy
j. Dyspnea
Causes Prevention Management
• Pressure on the • Assume a semi-Fowler’s
diaphragm exerted by position instead of a
the gravid uterus, supine position in bed,
especially in the third especially in the third
trimester: more before trimester, before
lightening & relieved by lightening.
lightening. • Wear loose clothes and
bra
• Have frequent rest periods
 Preventing Common
Discomforts in Pregnancy
k. Leukorrhea
Causes Prevention Management
• Elevated levels of • Flush perineum
estrogen stimulate after every voiding
increased activity of • Wear cotton
cervical glands, perineal pad for
resulting in the more comfort
production of whitish,
mucoid, non-foul
vaginal discharge,
called leukorrhea.
 Preventing Common
Discomforts in Pregnancy
l. Backache
Causes Nt. The use of a Management
• Faulty posture, fatigue • Maintain good posture: do
• Relaxed sacro-iliac pelvic rock/tilt exercises;
joint wear flat or low-heeled
• Prolonged shoes for better support
standing/sitting and balance.
• Strained on the back • Wear firm, supportive
muscles from an maternity girdle.
increased lumbar • Use a firm and comfortable
curve (lordosis) bed, especially in the third
trimester, to support the
relaxed sacroiliac joint.
The use of a small pillow
place along the lumbar
curve may also offer
support and comfort.