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09-09-2024 Normal OB

Oct 03, 20246 min read

Prenatal Checkup

Facility-based. Its frequency should be as follows (recommended by the DOH), and is more frequent if indicated by risk factors or abnormalities:

  1. Before the fourth month
  2. Before the sixth month
  3. Before the eighth month
  4. On the final month

History Taking

  1. Biological Profile: age, height, weight.
    • A good pregnant age is from 18 to 35. Being out of this range poses risk for intrauterine growth restriction (IUGR) resultant of hypertension. SGA may result in mental retardation or low IQ.
      • IUGR may be chronic or subacute; chronic IUGR results from hypertension early in the pregnancy, creating an evenly small body and head. A late onset of hypertension results in a disproportionate restriction of size between the body (smaller) and head, as progression is cephalocaudal, characteristic of subacute IUGR. Normal birth weight is 2,500 to 4,000 grams. Less is Small for Gestational Age (SGA), more is Large for Gestational Age (LGA).
    • A height of less than 5’ is considered a risk. A small height increases risk for cephalopelvic disproportion (CPD). If suspected, this requires pelvimetry via x-ray (never done on the first trimester, best done on the third trimester two weeks prior to EDC).
    • A weight of less than 90 lb or more than 150 lb is ideal as a prepregnant weight.
      • Normal weight gain during pregnancy: 24 to 30 lbs, maximum of 35 pounds: 1 lb per month on the first trimester, and 1 lb (±0.2) per week on the second and third trimester.
      • A lower than normal weight status may result in SGA due to anemia and lack of nourishment.
      • A higher than normal weight status may result in LGA due to the development of diabetes mellitus. This can result in maternal ketosis, which can cause cognitive impairment in the fetus, as ketones are able to cross the placental barrier.
  2. Obstetric History:
    • Menstrual History: Menarche (~12 y.o.), Regularity, Period, Last Menstrual Period (LMP)
    • OB Score; GPTPALM:
      • Gravida: number of pregnancies
      • Parity: number of deliveries regardless of outcome and number
      • Term: number of babies that reached term (37 weeks)
      • Preterm: number of babies that failed to reach term
      • Abortion: number of babies ended before the age of viability (20 weeks)
      • Living: number of babies delivered alive
      • Multiple: number of pregnancies with multiple fetuses

Estimates of Pregnancy

  1. Naegel’s Rule: estimation of the date of deliver (EDD):
    • LMP + 9 months + 7 days or + 1 year - 3 months, + 7 days
  2. McDonald’s Rule: for the estimation of the age of gestation in weeks.
    • divided in 4 for months.
  3. Bartholomew’s Rule: the use of the fundal location to estimate gestational age.
    • At the symphysis pubis: 0 months
    • Above the symphysis pubis: 3 months
    • Between the umbilicus and symphysis pubis: 4 months
    • At the umbilicus: 5 months
    • Above the umbilicus: 6 months
    • Between the umbilicus and xiphoid process: 7 months
    • Just below the xiphoid process: 8 months or late 9th month.
      • Recession of the fundus back to this level is caused by lightening, the setting of the fetus into the pelvic inlet. In primipara, they experience it 1 to 2 weeks before labor and delivery, but multipara experience it 1 to 2 days before labor and delivery.
  4. Haase’s Rule: estimated fetal length (cm). Square the month for the first five months, then multiply the month by five the next four months.
  5. Johnson’s Rule:
    • Estimated fetal weight (grams); check for ballottement.
      • Not Engaged:
      • Engaged:

Factors affecting Fundic Height

  • Number of fetuses: multiple fetuses
  • Size of the baby: SGA, LGA
  • Amount of amniotic fluid: poly/oligohydramnios
  • Size of mother

Pelvic Exam

  1. Fundic Height Measurement: measurement of the distance from the top of the symphysis pubis to the palpable fundic height. The patient is positioned in a dorsal recumbent position.
  2. Leopold’s Maneuver (LM)
    • Cardinal rule: void prior to the procedure. Catheterize if ordered. Ensure privacy.
    • L1 (Fundic Maneuver): to determine the lie of the baby, and which part of the fetus is occupying the fundal area. The back is smooth, and the front is rough and angular.
      • May be longitudinal, transverse, or oblique. Normally longitudinal, with the breech occupying the fundal space.
    • L2 (Lateral Maneuver): to find the back of the baby (between left, right, transverse). Alternate pressing on each side of the body to feel the fetus.
    • L3 (Pawlick’s Maneuver): to determine the presenting part (primary purpose) and ballottement/engagement (secondary purpose).
      • The presenting part is normally the head; cephalic. It is felt as round and hard.
      • If ballottement is present, then L4 is not done, as no attitude can be determined without engagement.
    • L4 (Pelvic Maneuver): flexion is normal. This is done once lightening and engagement has occurred to determine attitude.
  3. Internal Examination (IE): may be done to diagnose pregnancy (presumptive sign of)

Sample Questions

What is the goal of prenatal checkups?

  1. To identify risk factors early.
  2. To identify actual problems early.
  3. To manage actual problems early.
  4. To reduce neonatal and maternal mortality rate.

A woman weighing 120 lbs will be expected to weigh what by the fourth month of pregnancy?

  1. 127 lb
  2. 157 lb
  3. 137 lb
  4. 124 lb

What is the primary diabetogenic hormone in pregnancy?

  1. Estrogen
  2. Progesterone
  3. HPL
  4. HCG

Which hormone produced by the placenta allows for the relaxation of the ligaments of the pelvis for pregnancy?

  1. Estrogen
  2. Progesterone
  3. Relaxin
  4. HPL

Where are you going to place the zero of the tape measure?

  1. From the lower border of the symphysis pubis
  2. From the upper border of the symphysis pubis
  3. From the fundus

What is the best position of the mother for Leopold’s Maneuver

  1. Supine
  2. Dorsal Recumbent
  3. Prone
  4. Dorsal

What is the GP of a pregnant woman who has had one abortion and two full-term deliveries?

  1. G3P2
  2. G3P3
  3. G4P3
  4. G4P2

Which pair of leopold’s maneuver counterchecks one another?

  1. L1 and L3
  2. L1 and L2
  3. L2 and L4
  4. L3 and L4

A four month pregnant client is undergoing prenatal checkup. The doctor wishes to do an IE. The client asks what it is for.

  1. To determine cervical dilatation and effacement
  2. To determine the position, lie, attitude, and placement
  3. To determine Hegar’s sign, Chadwick’s sign, and Goodell’s sign.
  4. All of the above.

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