Prenatal Management

  1. Initial assessment: Goal: establish baseline for health supervision, teaching, emotional support, or referral.
  2. Objectives:
    1. Determine woman’s present health status and validate pregnancy.
    2. Identify factors affecting or affected by pregnancy.
    3. Determine current gravidity and parity.
    4. Identify present length of gestation.
    5. Establish an estimated date of birth (EDB). Nagele’s determination of EDB - subtract 3 mo, add 7 days to last menstrual period (LMP).
    6. Determine relevant knowledge deficit.
  3. Assessment: history
    1. Family - inheritable   diseases, reproductive problems.
    2. Personal - medical, surgical, gynecological, past obstetric, average nonpregnant weight.
      1. Gravida - a pregnant woman.
        1. Nulligravida - woman who has never been pregnant.
        2. Primigravida - woman with a first pregnancy.
        3. Multigravida - woman with a second or later pregnancy.
      2. Para - refers to past pregnancies (not number of babies) that reached viability (20-22 wk) (whether or not born alive).
        1. Nullipara - woman who has not carried a pregnancy to viability; e.g., may have had one or more abortions.
        2. Primipara - woman who has carried one pregnancy to viability.
        3. Multipara - woman who had two or more pregnancies that reached viability.
        4. Grandmultipara - woman who has had six or more viable pregnancies.
      3. Examples of gravidity/parity. Several methods of describing gravidity and parity are in common use. One method (GTPAL) describes number of “Gravida” (pregnancies), Term (or full-term infants), Preterm infants, Abortions, and number of Living children.
        1. A woman who is pregnant for the first time and is currently undelivered is designated as 1-0-0-0-0. After giving birth to a full-term living neonate, she becomes 1-1-0-0-1.
        2. If a woman’s second pregnancy ends in abortion and she has a living child from a previous pregnancy, born at term, she is designated as 2-1-0-1-1.
        3. A woman who is pregnant for the fourth time and whose previous pregnancies yielded one full-term neonate, premature twins, and one abortion (spontaneous or induced), and who now has three living children, may be designated as 4-1-1-1-3.
        4. Others record as follows: number gravida/number para. Applying this system to the examples given above, those mothers would be designated as follows: a - G1P1; b - G2P1; c - G4P2.
        5. Others include recording of abortions:
          • G1P1 AbO
          • G2P1 Abi
          • G4P2 Abi