PHYSICAL

ASSESSMENT OF
NORMAL
PREGNANT CLIENT
CI’s Name
COLLEGE OF NURSING
OUR LADY OF FATIMA UNIVERSITY
 FREQUENCY OF PRENATAL VISIT
TRIMESTER FREQUENCY OF VISIT
1ST (1-12 wks AOG) At least once
DOH 2nd (13-27 wks AOG) At least once
3rd (28-40 wks AOG) At least twice

AGE OF GESTATION FREQUENCY OF VISIT

WEEK 4 - 27 1 PER MONTH
Pillitte WEEK 28 - 36 1 EVERY TWO WEEKS
ri
WEEK 37 - 40 1 EVERY WEEK
PREPARATION BEFORE ASSESSMENT:

 Make sure to always provide comfort and sense

of privacy
 Have the needed equipment readily at hand
 Provide gown and drapes for abdominal
examination
 Instruct the client to empty her bladder prior to
examination
EQUIPMENT
 The examiners hand are the
“primary equipment” for
assessment
 Tape measure
 Stethoscope/ fetal Doppler
 Water-soluble gel
 Clean gloves (if needed)
 POSITION

 Sitting position
 Supine position
with pillow under
the legs
 GENERAL EXAMINATION
 Appearance – inspection of the overall health, nutritional
status, emotional state, neuromuscular coordination
 Weight, height
 BMI (prepregnant state)
 Vital signs

2
 HEAD AND NECK
 Hair: note for texture, moisture, and distribution, dryness, oiliness
 Eyes: anemia of pregnancy may cause pallor
 Nose: nasal congestion is common among pregnant women and nose
bleeds
 Mouth: inspect for gums and teeth, gingival enlargement with
bleeding is common
 Thyroid: symmetrical enlargement may be expected
 Skin pigmentation changes: Chloasma/melasma gravidarum –
irregular brownish patches of varying size appear on the face and
neck, “mask of pregnancy”
 Spider telanggieactasia – a vascular stellate marks resulting from
high level of estrogen. Typically develop in face, neck, upper chest
and arm
THORAX AND LUNGS
 Inspect thorax for the pattern of breathing

HEART
 Palpate for the apical impulse. Sometimes it may be slightly higher
than normal due to higher diaphragm
 Auscultate the heart; soft blowing are common, reflecting the
increased blood flow in normal vessels

BREAST
 Inspect breast and nipple for symmetry and color, nipple and areola become
bigger and darker
 Compress nipples with finger and thumb, may express colostrum
 ABDOMEN
 Inspect for skin changes: presence of Linea Nigra – darkening of the
linea alba
 Inspect for Striae gravidarum “stretch mark” due to stretching of
the abdomen, reddish or purplish in color and becomes silvery after
delivery
 Associated risk factors are weight gain during pregnancy, younger
maternal age, and family history
 Palpate for the fetal movement “quickening” 10-12 fetal kicks per
hour
 Braxton hick’s contraction – abnormal painless contraction
 Auscultation of fetal heart tone 120-160bpm
 Can be detected through stethoscope by 18 weeks AOG
 Can be detected through fetal Doppler at 10 – 12 weeks AOG
ABDOMEN
 Mc Donald’s rule: used to
determine the age of
gestation
 Length of the fundus in
cm x 8/7 = AOG in weeks
 Length of the fundus in
cm x 2/7 = AOG in months
ABDOMEN
 Bartholomew’s Rule – to
determine the age of gestation
by fundic location
 3 months – just above the
symphysis pubis
 4 months – midway between
symphysis pubis and umbilicus
 5 months – at the level of the
umbilicus
 JOHNSON’S RULE
 For estimation of fetal weight
 Fetal weight in grams = (fundic
height in cm) - n x 155
 n = 12 if the fetus is not engaged
 n = 11 if the fetus is engaged

 Example:
28cm – 11 = 17
17 x 155 = 2635gms
 ABDOMEN
 Haase’s Rule – to determine
the length of the fetus in
centimeter
 First half of pregnancy (1 – 5
months) --- months ²
 Second half of the pregnancy
( 6 – 10 months) month x 5
LEOPOLD’S MANEUVER
 Are a common and systematic
way to determine the position of a
fetus inside the woman's uterus
 Named after the gynecologist
Christian Gerhard Leopold.
 Also used to estimate term fetal
weight.
 LM 1 ( FUNDAL GRIP)

 Palpation of the fundus to

determine which fetal part
occupies the fundus
 Use finger pads and ulnar
surface of hands
 Fetal head should be round and
hard
 Buttocks soft and round
LM 2 (UMBILICAL/ LATERAL GRIP)

 To determine which side is

the fetal back, usually feels
like a hard, resistant, convex
structure
 Fetal extremities feels
nodular and irregular
 Fetal back is smooth and
broad (FHT)
LM 3 (PAWLIK’S GRIP)

 Suprapubic palpation using

thumb and fingers just
above the symphysis pubis
to determine degree of
engagement and ballotment
 To confirm fetal
presentation
LM 4 (PELVIC GRIP)

 Palpation of the
bilateral lower
quadrants to
determine fetal
attitude
 Only done when the
mother is near her
EDD/EDC/EDB
FETAL ATTITUDE
EXTREMITIES
 Inspect hands and legs for edema
 Palpate for pre-tibial, ankle and
pedal edema
 Physiologic edema is more common
in women who stands a lot
 Pathologic edema is often grade 3+
and often associated with PIH
 Check for leg varicosities
 GENITALIA
 Inspect for the hair distribution and color
 Scar from previous episiotomy or perineal laceration
 Inspect the anal area for varicosities (hemorrhoids)
 Inspect for vaginal discharge
 Inspect for warts, foreign body and smell
 Chadwick’s sign – bluish to purplish color of the vagina due to
increased vascularity
 Goodell’s sign – cyanosis and softening of the cervix, may occur
as early as 4 weeks AOG
 Hegar’s sign – softening of the uterine isthmus and can be
observed by 6th to 8th week AOG
CONCLUDING THE VISIT
 Once the examination is completed
instruct the client to get dressed
 Review findings
 Answer client’s questions
 Advise necessary laboratory procedures
that are needed
 Reinforce the importance of regular check
up
 Record findings in the chart of the client
PRACTICE COMPUTATION

Compute for the EDC/EDD and AOG:

LMP:
1. May 5, 2022
2. December 24, 2021
3. March 13, 2022
4. February 27, 2022
5. November 30, 2021
PRACTICE COMPUTATION
Compute for the EDC/EDD and AOG:

LMP: May 5, 2022

EDD = Feb 12, 2023 5 5 2022
-3 +7 + 1
2 12 2023
LMP: December 24, 2021
EDD = Oct. 1, 2022 12 24 2021
• Since September is only up to 30
-3 +7 + 1
days, add up another month to
9 31 2022 September because the month has
completed the no. of days.
(+1) -30 • Then subtract 30 days from the 31.
10 1 2022
PRACTICE COMPUTATION
Compute for the EDC/EDD and AOG:
LMP:
LMP: March 13, 2022
EDD = Dec. 20, 2022 3 13 2022
+9 +7
12 20 2022
LMP: February 27, 2022
EDD = Dec. 4, 2022 2 27 2022
• November is only up to 30 days, add
+9 +7 up another month to November
11 34 2022 because the month has completed
the no. of days. .
(+1) -30 • Then subtract 30 days from the 31.
12 4 2022
PRACTICE COMPUTATION

Compute for the EDC/EDD and AOG:

LMP:
LMP: November 16, 2021
EDD = August 23, 2022 11 16 2021
-3 +7 + 1
8 23 2022