Essential Procedures in Normal Pregnancy

ESSENTIAL PROCEDURES IN NORMAL PREGNANCY
ESTIMATING OVULATION TIME

• Estimating the exact time of ovulation in the menstrual cycle is of utmost important in
maternity care.
• According to Allen(1930), ovulation usually occurs approximately 14 days before the first day
of the succeeding menstrual bleeding, corresponding to the life of the corpus luteum.
• The time of ovulation may be estimated through the evaluation of the presence of some signs
and symptoms.
SIGNS AND SYMPTOMS OF OVULATION
A. Abrupt slight rise in basal body temperature (0.3– 0.5°C or 0.4-0.8°F), which is preceded by a
slight drop 24 to 36 hours before. The most fertile time is 3 to 4 days before ovulation and 1 to
2 days after.
-Taking the basal body temperature can be helpful and inexpensive indicator of ovulation for
the woman with regular cycle.
B. Presence of Mittelschmerz, the sensation of lower abdominal discomfort on the side of the
ovary that ovulated. Normally, only one ovary ovulates each month, this sensation is often
unilateral.
- The irritation of the peritoneum by the follicular fluid or blood that escapes from the Graafian
follicle at ovulation causes mittelschmerz.
C. Identification of fertile cervical mucus., brought about by the influence of the hormone
estrogen. Fertile cervical mucus is characterized as:
1. clear and transparent
2. slippery and lubricative
3. stringy, elastic and stretchable
4. having a positive Fern test
POSITIVE SPINNBARKEIT TEST
• Before ovulation, cervical mucus threads are 1 to 2 cm long.
• The ability of cervical mucus to be stretched up is termed spinnbarkeit.
• The period of fertility is the span of time that a woman is likely to be pregnant when she
engages unprotected sex.
• The absolute period of fertility is the time of ovulation
• The ovum or egg cell lives for an average of 24 hours and is most likely to be fertilized
between 12 to 24 hours.
• The woman is most infertile during the period of menstruation, 1-4 days of menstrual cycle.
TAKING COMPLETE MENSTRUAL HISTORY
• During the first prenatal visit, the menstrual history should be taken systematically, accurately
and completely.
• The menstrual history-taking is done with sensitivity and without haste in order not to omit
any vital information that may be necessary in dating pregnancy, identifying age of gestation
and evaluating pregnancy to determine if there is an existing high-risk condition.
MENSTRUAL HISTORY TAKING
A. MENARCHE. This is the first menstruation. Inquire about its duration and characteristics.
Menarche occurs between 12 to 13 years of age. First menstruations are characteristically
irregular, anovulatory and infertile
B. DURATION OF MENSES. Usual duration is 2-4 days
C. INTERVAL BETWEEN MENSES. 28 days mean interval in between menstrual periods. Although
21 to 35 days is considered normal range.
D. CHARACTERISTICS OF MENSTRUAL FLOW. Menstrual flow can be described as scanty,
normal, and heavy. Ask if there are clots or none. 25-60 ml.- normal amount of blood lost
during menstrual period.
E. PRESENCE OF MITTELSCHMERZ or mid-cycle pain
F. DATE OF LAST MENSTRUAL PERION (LMP). Consider the duration and character of LMP.
Check if it is normal menstrual period and not implantation bleeding.
G. DATE OF PAST/PREVIOUS MENSTRUALL PERIOD
(PMP). The menstrual period before the last is the
PMP.
H. ASK ABOUT MENSTRUAL ABNORMALITIES OR PROBLEMS
1. AMENORRHEA.
Absence of menstruation. Amenorrhea is considered primary when menarche has never
occurred. It is related to thyroid gland abnormality, typically hyperthyroidism. While secondary
amenorrhea is
2. DYSMENORRHEA.
It is painful menstruation . Primary dysmenorrhea occurs in the absence of any underlying
anatomic abnormality. Secondary dysmenorrhea occurs when there is an underlying structural
abnormality of the cervix or uterus (eg. Malposition), a foreign body (eg. IUD), pelvic
inflammatory disease (PID), endometriosis or endometritis.
3. METRORRHAGIA.
Abnormal bleeding between menses/periods. It may be related to PID. Uterine fibroids, corpus
carcinoma, erosion and cancer of the cervix.
4. MENOMETRORRHAGIA.
Excessive or prolonged menstrual bleeding which could lead to hypovolemia and anemia.
5. PREMENSTRUAL SYNDROME.
PMS is described as “complex physical signs and behavioral symptoms that occur during the
second half of the menstrual cycle and that resolve with the onset of menses. Signs and
symptoms are varied and multisystems”
SIGNS AND SYMPTOMS OF PMS PER SYSTEM
Psychologic: lethargy, irritability, depression, sleep disorders, tearfulness/crying spells, anxiety,
hostilityNeurologic: migraine, vertigo, syncope
GI: nausea, vomiting, bloating, constipation, craving for sweets and salty foods
MAMMARY: swelling, breast fullness and tenderness
RESPIRATORY: asthma, coryza, hoarseness
URINARY: oliguria, retention
DERMATOLOGIC: acne
DETERMINING GRAVIDITY AND PARITY
 A gravida is a pregnant woman.

 A nulligravida or gravida 0 is a woman who has never been pregnant.
 A primigravida or gravida 1 is a woman who is pregnant for the first time or has been
pregnant one time.
 A multigravida or more specifically a gravida 2 (also secundigravida), gravida 3, and so
on, is a woman who has been pregnant more than one time.
 An elderly primigravida is a woman in her first pregnancy, who is at least 35 years old.
This term is becoming less common as it may be considered offensive.
 The term gravida is generally coupled with para (and occasionally additional terms) to
indicate more details of the woman’s obstetric history.
 A woman who has never given birth is nullipara, a nullip, or para 0.
 A woman who has never completed a pregnancy beyond 20 weeks is also referred to as
being nulliparous, a nullipara or para 0.
 A woman who has given birth one or more times is referred to as para 1, para 2, para 3
and so on.
 A woman in her first pregnancy and who has therefore not yet given birth is nullipara.
After she gives birth, she becomes a primipara.
 A woman who has given birth once before is primiparous, and would be referred to as a
primipara.
 A woman who has given birth two or more times is multiparous.
 Grand multipara refers to a (grand multiparous) woman who has given birth five or
more times.
 Gravida indicates the number of times the mother has been pregnant, regardless of
whether these pregnancies were carried to term.
 A current pregnancy, if any, is included in this count.
 Para indicates the number of >20 weeks births (including viable and non-viable i.e.,
stillbirths).
 Pregnancies consisting of multiples, such as twins or triplets, count as ONE birth for the
purpose of this notation.
 Abortus is the number of pregnancies that were lost for any reason, including induced
abortions or miscarriages. The abortus term is sometimes dropped when no pregnancies
have been lost. Stillbirths are not included.

Essential Procedures in Normal Pregnancy

Uploaded by

Copyright:

Available Formats

Essential Procedures in Normal Pregnancy

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Essential Procedures in Normal Pregnancy

Uploaded by

Copyright:

Available Formats

ESSENTIAL PROCEDURES IN NORMAL PREGNANCY

ESTIMATING OVULATION TIME

 A gravida is a pregnant woman.

You might also like