Assessment During Pregnancy

Assessment during pregnancy involves evaluating maternal and fetal health with the goal of a healthy pregnancy outcome. During the assessment, you’ll collect subjective data, or information your patient states, as well as objective data, or information you collect through observation.

Begin by collecting information about your patient’s reproductive and sexual health. Ask about their history of gynecological surgeries, especially those involving the cervix, since this could increase the risk of cervical insufficiency and early pregnancy loss; or the uterus, since this can increase the risk of obstetric complications like fetal malpresentation or uterine rupture.

Also, review your patient’s obstetric history using the GTPAL notation, to document Gravidity or how many times your patient has been pregnant; the number of Term pregnancies and Preterm births; if they’ve had either a spontaneous or elective Abortion; and the number of Living children.

Lastly, determine if they have a history of sexually transmitted infections, or STIs, which are risk factors for premature rupture of membranes, preterm labor, as well neonatal infections and birth defects.

Next, focus on their current pregnancy. Ask them about the first day of their last menstrual period and use this date to calculate the expected date of delivery, or EDD for short, using Naegele’s rule.

Then, inquire about any new symptoms like pain, vaginal discharge, fatigue, or nausea and vomiting. Also be sure to ask them how they are feeling about their pregnancy, if the pregnancy was planned, and if they have any concerns that could adversely affect their pregnancy, such as intimate partner violence, lack of social support, or economic constraints.

Finally, review their medical history. Inquire about conditions that could complicate the pregnancy, like diabetes, hypertension, or asthma; current medications; known allergies; and immunizations.

Also ask about their daily routine, including diet, physical activity, and sleep, as well as intake of caffeine and use of alcohol or tobacco products.

Okay, next perform a focused physical assessment. First, observe your patient’s general appearance, including posture, grooming, and affect.

Then, assess their vital signs and measure their height and weight. Inspect their skin, making note of any previous cesarean section scars and the presence of pregnancy-related skin changes like chloasma, which is a dark pigmentation across the nose and face; or a dark vertical line on the abdomen called linea nigra.

Inspect their breasts for normal variations, like flat or inverted nipples, especially if your patient plans to breastfeed.

Then, gently palpate the breast tissue, which may have a nodular feeling due to enlargement of the alveoli within the breast.

Also keep in mind that their breasts might be tender because of increased levels of estrogen and progesterone. Moving on to your patient’s respiratory and cardiovascular system, begin by observing their breathing pattern and auscultate breath sounds noting any adventitious sounds like crackles or wheezes.

Breathing should be unlabored early in pregnancy, though your patient may experience shortness of breath as the growing uterus pushes up against the diaphragm.

Next, auscultate your patient’s heart sounds, making note of any abnormal sounds, like murmurs, clicks, or rubs. Because of the increased blood volume that occurs during pregnancy, you may notice a soft, blowing systolic murmur, which typically resolves after pregnancy.

Also be sure to inspect your patient’s lower extremities, checking for varicosities, which often occur as the pregnancy progresses, and edema, which could be related to varicosities or preeclampsia.

Now, by about the 12th week of pregnancy, you should be able to palpate your patient’s fundus, or top of the uterus. Starting around the 16th week of pregnancy, you’ll assess your patient’s fundal height in centimeters, measuring from the top of the uterine fundus to the symphysis pubis.

The measurement approximates the weeks of gestation, plus or minus 1 to 2 centimeters. So, for example, if you measure a fundal height of 26 centimeters, this indicates the pregnancy has progressed to about 26 weeks of gestation.

You'll also assess the fetal heart tones, or FHTs, which can be heard by doppler ultrasound, starting at about 8 weeks of gestation.

Count the FHTs for six seconds and then multiply by ten. A normal fetal heart rate should be between 110 and 160 beats per minute.

Finally, collect blood for routine prenatal tests. These include blood type and Rh factor; complete blood count with differential; antibody screens for Rh, rubeola, and varicella; rubella titer; and tests like rapid plasma reagin, or RPR test for syphilis.

Other tests include hepatitis B and HIV serology. A urinalysis should also be done to check for glucose, protein, red and white blood cells, and bacteria; and cervical smears should be collected to screen for gonorrhea and chlamydia.

Alright, as a quick recap...Assessment during pregnancy involves evaluating maternal and fetal health with the goal of a healthy pregnancy outcome.

During the assessment,