GTPAL

Gravida- Total # of pregnancies, including present one

Term- # of baby 37weeks above
Preterm- # of baby below 37weeks
Abortion- # of spontaneous or induced abortion
Living- # of Alive children
**M-Multiple Pregnancies
**Para- # of baby born 24weeks above dead/alive

E.g. A pregnant mother on here 3rd month of pregnancy, came to the clinic for her prenatal visit. She stated that, she
had an abortion few years ago before her 1st daughter was born. Now, she is having her 4th baby and exited but a little
afraid, since her twin babies, went out 8 weeks before their due date.

Gravida-4 Para-2
T-1 P-2 A-1 L-3 M-1

SIGNS & SYMPTOMS OF PREGNANCY: DIAGNOSIS

PRESUMPTIVE SIGNS: (SUBJECTIVE PROBABLE SIGNS: (OBJECTIVE SIGNS) POSITIVE SIGNS OF PREGNANCY:
SIGNS) -Changes felt by Patient Changes observed by Examiner DEFINITIVE Signs
M –orning Sickness C –hadwicks sign (bluish-purplish H-EARTBEAT(separate from Mother
A –menorrhea vagina) -10-12 weeks by Doppler
C –hanges in Breast (1-2wks) H–egars sign (softening lower uterine -16 –20 weeks by auscultation
F–atique (12-18wks) segment) M-ovement felt by the examiner
U–rinary Frequency (3wks) U –terine enlargement (12 weeks) usually 16-20 weeks (5mos AOG)
Q–uickening (16–20wks) P –ositive pregnancy test F-etal outline by ultrasound (16 to 18
B–allottement (bouncing of baby) weeks done)
B -braxton hicks (28 weeks -painless
contraction)
O–utlining of fetal body
G–oodells sign (softening of cervix)
S–kin color changes

Nagele's rule
Ask the patient to state the first day of her last menses.
(-3 mos +7 days)
Pinoy’s Rule
1. Jan-Mar  +9 months +7 days
2. Apr-Dec  -3 months +7 days + 1 year

Example
LMP: 02/13/2021 LMP: 06/27/2021
 2+9= 11  06-3= 03 03/34/2022 (March 31 days)
 13+7=20  27+7=34  03+1=4
 2021+1= 2022  34-31=3
EDC Answer: 11/20/2021 Answer: 04/03/2022

Weeks of AOG Frequency of Clinic Visit

0-32weeks Once a Month
32-36weeks Twice a Month
36weeks Onwards Every Week

5 FACTORS OF LABOR (5Ps)

FACTOR DEFINITION
1. PASSAGEWAY *Shape and Measurement of maternal PELVIS and distensibility of birth canal
2. PASSENGER A. FETAL HEAD
-FONTANELS- used as landmarks for internal exam during labor determine position of fetus.
-6 fontanels but only 2 PALPABLE (Anterior/Bregma and Posterior/Lambda)

B. PRESENTATION
 1. CEPHALIC- head is presenting (Vertex, Brow, Face, Mentum, Sinciput)
2. BREECH- Buttocks or lower extremities presenting (Frank- buttocks, Full/complete- buttocks
and feet, Footling- one or both feet)
3. SHOULDER- Shoulder presenting
3. POWERS
4. PSYCHE
5. PLACENTA
Fetal Assessment
Fetal Assessment Purpose & Normal Values & Nursing Care
1. Alpha-fetoprotein AFP *AFP Begins to RISE 11weeks AOG. Maternal AFP= 10 ng/ml to 150 ng/ml
(15-20weeks) a. If HIGHER = Risk for NEURAL TUBE DEFECTS
b. IF LOWER = Risk for TRISOMY 21 or 18
2. Amniocentesis *Amniotic Fluid Analysis (15ml), Detect Fetal Abnormalities, Determine FETAL LUNG MATURITY
(14-16weeks) *Determine certain INFECTION
NSG Responsibilities:
1. EMPTY BLADDER
2. SUPINE position with rolled towel under RIGHT HIP
3. Deep breath and hold it while needle is inserted
4. FHT monitoring BEFORE, DURING and 30min AFTER
5. Report if- Infection (>body temp), Uterine Cramps, Vaginal Bleeding.
3. Chorionic Villi Sampling *Transcervical or Transabdominal insertion of needle into the fetal portion of placenta
(8-10 weeks)- UTZ-guided *CHORIONIC VILLI CELLS - for Chromosome DNA ANALYSIS
*CHROMOSE Abnormalities (eg trisomy 21/down syndrome
4. Biophysical Profile (BPP) *NON-INVASIVE method of assessing GENERAL WELLBEING of the Fetus
(26-28weeks) *Use of UTZ and electronic FHT
*Duration: 30minutes
*BPP Scoring= 8-10 NORMAL HEALTHY FETUS
*Per PARAMETER Normal Score= 2 ; Abnormal= 0
*5 PARAMETERS
1. FETAL BREATHING- 1 episode per 30sec of sustained fetal breathing movements (within 30mins)
2. FETAL MOVEMENT- 3 separate episodes of fetal limb or trunk movements (within 30mins)
3. FETAL TONE- 1 episode where Fetus Extends then Flexes extremities or spine (within 30mins)
4. AMNIOTIC FLUID INDEX- pocket of amniotic fluid measuring 1cm in vertical diameter must be
present
5. REACTIVE FHT from NON-STRESS TEST (NST)- 2 or more accelerations at least 15 beats/min
above baseline and 15 sec duration occur over 20 min
5. Fetal Kick Count or Fetal *Daily Recording
Movement *10kicks, flutters, swishes or rolls (10 movements within 2 hours)
*IF less than 10 or No Fetal kicks by the end of the second hour. Wait for few hours and try again. If
for the 2nd time less than 10 movements within 2hours= NOTIFIY HEALTH CARE PROVIDER
6. Non-Stress Test (NST) *FETAL HEART to FETAL MOVEMENT- Placental function and oxygenation
(27weeks) *FHT= Should INC by 15beats for at least 15seconds, 2x in a 20mins period
*DETERMINATION
1. REACTIVE NST= HEALTHY
2. NON REACTIVE NST= Health issue need to re-assess with CST
7. Contraction Stress Test *Assess if Fetus will STAY HEALTHY during Reduced oxygen Levels
(CST) or Oxytocin Stress Test *Stimulate Contraction using OXYTOCIN or NIPPLE STIMULATION
(OST) (>34weeks) *FHT and Mother’s CONTRACTION recorded for 10 minutes, Duration: 60-90minutes to perform
*DETERMINATION
1. NEGATIVE: No late deceleration in 10mins. FETUS IS SAFE or HEALTHY for the next 7 days.
2. POSITIVE: FETUS IS NO LONGER receiving adequate O2
FHT Rate Patterns
E- EARLY Deceleration  H-HEAD Compression
V- VARIABLE Deceleration C-CORD Compression
A- ACCELERATION  O-OKAY
L- LATE Deceleration  P-PLACENTAL Insufficiency

FIRST TRIMESTER Maternal Bleeding Disorders

Types Sub Types Signs and Symptoms Management

A. ABORTION 1. Spontaneous Vaginal Spotting  Depends on symptoms
2. Threatened Slight bleeding, +FHT, NO cervical  Avoid strenuous activities for 24-48 hours
Dilation, NO passage of tissues  Emotional support
 No coitus for 2 weeks
3. Inevitable Slight bleeding, Mild uterine  D/C
cramping, WITH cervical dilation  Assess vaginal bleeding
and passage of tissues
4. Complete Entire expulsion, Bleeding usually  Further observation
slows down within 2 hours & then  Emotional support
ceases within a few days after
passage of products of conception
5. Incomplete Expulsion of a part, heavy bleeding,  D/C
severe cramping, open cervical os,
passage of tissues.
6, Missed Fetus DIES in UTERO but not  D/C
expelled,  Cytotec- dilate cervix
Painless vaginal bleeding, no  Oxytocin- induce contractions (>14weeks)
cramping, no passage of tissue, no
 FHT, decrease in fundic height,
dark brown vaginal discharge
7. Habitual or 3 or more spontaneous abortion,  Depends on symptoms
Recurrent due to incompetent cervix,  Emotional support
pregnancy loss defective sperm, deviations of
uterus or infection.
8. Septic Abortion dure to infection  Antibiotic
 NO SEXUAL CONTACT
 Surgery
B. ECTOPIC knife-like pain in lower quadrant ( indicates tubal 1. Monitor vital signs ; maintain IV infusion for
PREGNANCY rupture) with referred shoulder pain administration of blood products, analgesics, antibiotics
 lower unilateral abdominal tenderness, cramps r/t 2. Prepare the patient (physically & emotionally) for
stretching of the tube, vaginal spotting, profound shock surgery
if ruptured 3. Provide emotional support
 Positive CULLEN’S SIGN- bluish umbilicus  Mifepristone( Korlym, Mifeprex-
Cat X)- abortifacient is effective in sloughing of the
implantation site
 Methotrexate (Trexall - Cat X)- folic acid antagonist
chemotherapeutic agent attacks and destroys fast growing
cells
Ruptured- LAPAROSCOPY to ligate the bleeding vessels
or to remove or repair the damage fallopian tube
 If tube is removed, 50% fertile SALPINGECTOMY
 If not ruptured SALPINGOTOMY

SECOND TRIMESTER Maternal Bleeding Disorders

Types Signs and Symptoms Management
A. HYDATIDIFORM -GRAPE -SIZED VESICLES- Embryo fails to develop -Suction and curettage; hysterectomy (over 40)
MOLE -COMPLETE- lacks embryo or fetus -Serum hCG is analyzed every 2 weeks until levels are
-INCOMPLETE/PARTIAL- Abnormal fetus normal, and every MONTH for 6 to 12 mos.
-UTERUS- EXPAND FASTER than normal (contraceptives should be advised for 12 months)
-NO FHT - gradually declining HCG titers suggest no complication
-hCG 1-2milion IU instead of Normal 400,000 IU - hCG levels that plateau for 3x or increase suggest that
-EXCESSIVE N/V due to high hCG malignant transformation has occurred
- methotrexate (antimetabolite/ anticancer prevents
choriocarcinoma
B. INCOMPETENT -a cervix that dilates prematurely and - Mc Donald/Shirodkar -cervical cerclage, 2-14 weeks
CERVIX therefore cannot hold a fetus until term AOG purse string suture
- pink stained vaginal discharge, painless dilatation

THRID TRIMESTER Maternal Bleeding Disorders

Types Signs and Symptoms Management
A. PLACENTA -Low implantation of the placenta -SIDE-LYING Position and CBR w/o BRP
PREVIA -4 Types: Low lying, Marginal, Partial, Total -AVOID COITUS
-MALE fetus-more likely -Inspect Bleeding
-INC risk for CONGENITAL abnormalities -Baseline V/S and Monitor FHR
-DEATH- if optimal fetal nutrition or oxygenation. -DOUBLE SET-UP Vaginal Examination- NO DIGITAL
-ABRUBPT, PAINLESS BRIGHT RED BLEEDING VAGINAL or RECTAL EXAM. -> Can only be done if final
and definitive event under double set-up
DIAGNOSTIC
-UTZ, APT or Kleihauer-Betke Test (fetal or
maternal blood)
B. ABRUPTIO -Premature Separation of Placenta -LATERAL position Bed rest.
PLACENTA -SHARP STABBING PAIN, DARK RED BLEEDING -IVF & O2 as prescribed
-Hard, rigid, firm, board-like abdomen -Monitor FHR, Maternal V/S and blood loss
-INC risk if - COCCAINE & Cigarette- - NO DIGITAL VAGINAL or RECTAL EXAM.
vasoconstriction -IVF administration of Fibrinogen
-‘E’ CS
OTHER Maternal Complications
Types Signs and Symptoms Management
A. PRETERM LABOR -Labor <37 weeks AOG STOP LABOR- If Fetus is OK, Cervical dilation not >4, cervical
-Persistent Uterine Contractions (dull, effacement not >50%
lowbackache) 1. BED REST
-Vaginal spotting, pelvic pressure, abdominal 2. IVF hydration to minimize release of Oxytocin
tightening, menstrual like cramping 3. Vaginal & cervical cultures, u/A to r/o infection
-INC vaginal discharge, uterine contractions, 4. MEDICATIONS
Intestinal cramping. a. TERBUTALINE (Oral tocolytic)- To stop labor up to 48H-
72H or until 37weeks or until fetal lungs have matured
b. MAGNESIUM SULFATE- Anti uterine contraction
c. CORTICOSTEROIDS- to accelerate lung surfactant
 Betamethasone 2 doses of 12 mg given IM 24 hours apart
 Dexamethasone 4 doses of 6 mg given IM 12 hours apart

CONTINUE LABOR- If Ruptured Membranes -> Point of No

return
-Risk for Cord Prolapse
B. PREMATURE -Early Rupture of Fetal Membranes <37weeks Diagnostics
RUPTURE OF AOG 1. Nitrazine Paper (blue color)
MEMBRANES (PROM) -Sudden gush of clear fluid from the -yellow-olive green (Negative, Intact membranes)
vagina (with continued minimal leakage) -Blue (Positive, probably ruptured)
2. Sonogram

Mx: INDUCED LABOR- Oxytocin

C. CORD PROLAPSE -displacement of the umbilical cord -Prevention: place the woman on bedrest after membranes
below the presenting part, the cord may have ruptured
protrude through the cervix and into the -KNEE CHEST or TRENDELENDBURG POSITION
vaginal canal
-DANGER: Fetal Hypoxia
-Diagnostics: IE