Assessment Admission

❖ Birth imminence❖ Fetal status ❖ Maternal status ❖ Risk assessment

Tips If a woman presents with ℅ bleeding ask her how man sanitary napkins she has saturated in an hour.

Assessment of reproductive history Gravida: Number of pregnancies the woman has had regardless of outcome Nulligravida: never been pregnantMultigravida: more than one pregnancyParity: the client communicates outcome of previous pregnanciesGTPAL : G: Gravida – the total number of pregnancies regardless of outcome T: Term – the number of pregnancies that ended at term (at or beyond 38 weeks’ gestation) P: Preterm – the number of pregnancies that ended after 20 weeks and before the end of 37 weeks’ gestation either A : Abortions – the number of pregnancies that ended before 20 weeks’ gestation either spontaneous or inducedL: Living – the number of children delivered who are alive when the history is taken

Components of assessment Obstetric History

❖ Number and outcomes of previous pregnancies in GTPAL (gravida, term, preterm, abortions, living) format (see Chapter 7 for a detailed explanation of these terms)

❖ Estimated delivery date❖ History of prenatal care for current pregnancy❖ Complications during pregnancy❖ Dates and results of fetal surveillance studies, such

as ultrasound or nonstress test (NST)❖ Childbirth preparation classes❖ Previous labor and birth experiences

Current Labor Status❖ Time of contraction onset❖ Contraction pattern including frequency, duration,

and intensity❖ Status of membranes❖ Description of bloody show or bleeding❖ Fetal movements during the past 24 hours

Medical–Surgical History❖ Chronic illnesses❖ Current medications❖ Prescribed❖ Over-the-counter❖ Herbal remedies

Social History❖ Marital status❖ Support system❖ Domestic violence screen❖ Cultural/religious considerations that affect care❖ Amount of smoking during pregnancy❖ Drug and alcohol use during pregnancy

Desires/Plans for Labor and Birth❖ Presence of a partner, coach, and/or doula (see

Chapter 7 for discussion of doulas)❖ Pain management preferences❖ Other personal preferences affecting intrapartum

nursing care❖ Presence of a birth plan❖ Desires/Plans for Newborn❖ Plans for feeding—breast or formula❖ Choice of pediatrician❖ Circumcision preference, if the infant is male❖ Rooming-in preference (Hatfield 208)

Prenatal visits Ist visit : ❖ Family History, Medical Surgical History,

Social History, Teaching, Avoiding teratogenic, substance ingestion, Alcohol, tobacco, illegal drugs, etc., Diet, nutrition, and exercise, Infection control

❖ Medication use ❖ Determining due dates ❖ Naegele's rule❖ Add seven days to the date of the first day of

the LMP, then subtract three months (and add a year)

❖ Pelvic examination❖ Practitioner sizes the uterus to estimate term❖ Obstetric sonogram: High frequency sound

waves reflect off fetal and maternal pelvic structures, allowing structure measurement