Presumptive indications : Amenorrhea Nausea and vomiting Fatigue Urinary frequency Breast and skin changes Cervical color changes Quickening Probable indications : Abdominal enlargement Cervical softening Ballottement Braxton hicks contraction Palpation of fetal out line Pregnancy tests in blood and urine Positive indications : Auscultation of fetal heart beats Feeling the fetal movements by examiner Ultrasound visualization of The conception

1 st 12 weeks : Amenorrhea Morning sickness Breast changes Change appetite Sleepy and depressed weeks : Amenorrhea Breast changes Morning sickness Braxton hicks contraction ballottement weeks : Palpation of fetal parts Fetal movements FHS Umbilical souffle Seeing of fetal movement Seeing of fetal skeleton by sonar Breast sensitivity Secretion of cholestrum Softening of uterus Cervix,vagina changes hCG in : Urine : one week after missed period Blood : before one week of missed period (After implantation ).

Definitions : Ante : before Natal : delivery Antenatal : before delivery Antenatal care : comprehensive health supervision of pregnant woman. Gravida : refers the number of pregnancies regardless of duration of the pregnancy Para: refers to the number of pregnancies that end at 20 weeks or more.

To reduce maternal mortality and morbidity rate Improve women and children health Prepare woman for labor, lactation and care of her infant Early detection and early treatment of complicated conditions.

Antenatal Room : Preparation : 1.Trays :VS, Immunization, medication 2.Furniture 3.Stationary 4.Visual display 5.Weighting room 6.Scales 7.Urine traces Nursing roles : 1.Welcoming 2.Privacy 3.History 4.Physical examination

History Personal Hx: Name Address Age Education Occupation Duration of marriage Religion Finance M&S Hx: Immunization Chronic illness Infection STD Anemia Smoking Allergies Drug sensitivity Gynecological Elimination Blood transfusion Family Hx: Chronic disease TB,HB Genetic/ congenital abnormalities Smoking Rh factor Obstetric Hx:

(GTPAL) for pregnancy out come Gravida,Para, abortion,living births Weight of infant at birth Length of gestation of previous pregnancy Previous child sex Labor experience, type, location,name of care giver Type of anesthesia Maternal /fetal complication (DM, HTN, bleeding,infection) Feeding of infant Date of last delivery Contraceptive history /complication Menstrual history : 1.Age of menarche 2.Regularity,Duration and frequency of MP 3.Any previous treatment of MP or infertility 4.LMP /EDD

Naagele’s rule: 1 st day :add 7 days Month : subtract 3 Year : add one year (adjusted )

Mrs. H. newly notice that here manse is absent for two weeks ago, she want to confirm that she is pregnant or not, what will you advice her to do ? What other changes you will ask about? Could you look for positive sign for Pregnancy at this time in case of Mrs. H? Group one (5STU):

Positive hCG in the urine, categories in which pregnancy indications? what others related indication you could look for ? If Mrs. H is not accurate about the date of her LMP, What other investigations could help in determine Pregnancy age - later on ? If she is pregnant give her antenatal visits schedule ? Group 2 (5STUD)

Case two : Alma has 2males children and 3 females, one of her sun born at 39 weeks, the other is term but is handicap. two of her daughters born as preterm twins at 36weeks. She delivered one dead baby two years ago, and she have 2abortins.now she is pregnant for 14weeks.

Group 3 (5STUD) Report complete obstetric history ? Add extra question if you need ? Classify gravida and Para ?

If you told by this client that LMP is : 2/1/2009 Calculate EDD? Group4 (4STUD)

If you told by this client that LMP is : 1/12/2008 Calculate EDD? Group5 (4STUD)

If you told by this client that LMP is : 31/ 1/2009 Calculate EDD? Group6 (4STUD)