1. بسم الله الرحمن الرحيم

2. Assessment childbearing womanBy
Mrs/ Hamdia Mohammed

3. 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.

4. 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.

5. 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.

6. Assessment childbearing client
Diagnosis of the pregnancy:
Rapid serum pregnancy test.
Presumptive, probable and positive signs of pregnancy.
Laboratory tests.

7. 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

8. Presumptive, probable and positive signs of pregnancy

10. 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.

11. 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)

12. 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.

13. 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
Fetal heart audible
Doppler ultrasound reveals heart beat

14. 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

15. 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

16. 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

17. Striae gravidarum

18. Linea negra

19. Melasma

20. 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 hours after implantation.

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

22. 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

23. 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

24. Fundal Palpation

25. 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

26. Lateral Palpation

27. 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

28. Pawlik’s maneuver (gribs)

29. 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

30. Pelvic palpation

31. Abdominal gribs

32. 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)

33. The mouth Angular cheilitis B vitamin deficiency Fungal infections
Over-biting

34. “Gingivitis of pregnancy”

35. The mouth Mild aphthous ulcer (AKA canker sore) Viral, bacterial
Stress
Underlying immune disease if frequent

36. Cyanosis of nail beds

37. Edema