بسم الله الرحمن الرحيم

Assessment childbearing woman 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 assess pregnant woman.

Preconception assessment Preconception assessment including: Nutritional intake (e.g., sufficient intake of folic acid). Life style (e.g., drinking and smoking habits). Woman’s health status. Identify any potential problems (e.g., ectopic pregnancy). Identify the woman’s understanding and expectations of conception, pregnancy, and parenthood.

Assessment elements during pregnancy Assessment elements during pregnancy including: Woman’s health status. Nutritional status as well as the well-being of the fetus is important throughout pregnancy. Assess the woman’s physiologic adaptation and the family’s psychological adaptation to pregnancy. Noting any abnormal findings. Physical findings are gained though health history. Physical assessment. Laboratory tests.

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 from implantation (weeks) Presumptive finding Probable finding Description 1 Serum laboratory tests Tests of blood serum reveal the presence of human chorionic gonadotropin hormone 2 Breast changes Feeling of tenderness, fullness, or tingling; enlargement and darkening of areola. Nausea & vomiting Nausea or vomiting on arising

Presumptive, probable and positive signs of pregnancy

Signs and symptoms of pregnancy are divided into three: 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 implantation (weeks) Presumptive finding Probable finding Description 2 Amenorrhea Absence of menstruation 3 Frequent urination Sense of having to void frequently 6 Chadwick’s sign Color change of the vagina from pink to purplish-blue (violet)

Presumptive, probable and positive signs of pregnancy Time from implantation (weeks) Presumptive finding Probable finding Description 6 Goodell’s sign Softening of the cervix Hegar’s sign Softening of the lower uterine segment Sonographic evidence of gestational sac Characteristic ring is evident.

Presumptive, probable and positive signs of pregnancy Time from implantation (weeks) Presumptive finding Probable finding **Positive finding Description 8 Sonographic evidence of fetal outline Fetal outline can be seen and measured by sonogram 10 - 12 Fetal heart audible Doppler ultrasound reveals heart beat

Presumptive, probable and positive signs of pregnancy Time from implantation (weeks) Presumptive finding Probable finding **Positive finding Description 12 Fatigue General feeling of tiredness Uterine enlargement Uterus can be palpated over symphysis pubis 16 Ballottement When lower 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 from implantation (weeks) Presumptive finding Probable finding **Positive finding Description 18 Quickening Fetal movement felt by woman 20 Fetal movement felt by examiner Fetal movement can be palpated through abdomen Braxton Hicks sign Periodic uterine tightening occurs. Fetal outline felt by examiner. Fetal outline can be palpated through abdomen

Presumptive, probable and positive signs of pregnancy Time from implantation (weeks) Presumptive finding Probable finding **Positive finding Description 24 Linea nigra Line of dark pigment on the abdomen Melasma Dark pigment on face. Striae gravidarum Red streaks on abdomen

Striae gravidarum

Linea negra

Melasma

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.

Leopold’s Maneuver Four-part process Determine the position of the baby in utero Determine the expected presentation during labor and delivery 21

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 woman’s R side facing her for the first 3 steps, then turn and face her feet for the last step (L handed, left side). 22

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 23

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”) 25

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 what’s in the fundus) Head will feel firm Buttocks will feel softer and irregular If it’s not engaged, it may be gently pushed back and forth Proceed to the 4th step if it’s not engaged… 27

Pawlik’s maneuver (gribs)

Fourth Maneuver Flexed/Deflexed/Extended? Turn to face the woman’s 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 29

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