1^{st trimester:}

-collect history - such as biographical data, occupation, religion, age, cultural background and marital status

- health status - nutrition, habits ( smoking, alcohol)

- Medical and Family history - chronic disease or infections, genetic disorders

- Menstruation history- date of last menstrual period, contraceptive use, estimated date of delivery

- Obstetric history - # of prev pregnancies, date and duration of previous pregnancies, type of birth

-Measurements - Weight and height, Vital signs

-pulse may increase 10-15 bpm

-resp may increase slightly

-BP while seated

- Musculo skeletal - posture, gait, back of legs for varicose veins or bluish stars

Evaluate head and eyes - brownish mottling over cheeks and forehead is normal - called cloasthma or mask of pregnancy, eyelids may be hyper-pigmented, conjunctiva should be pink, paleness may mean anemia.

Ears - eustachian tubes may be enlarged and blocked due to increase of estrogen

Nasal - nosebleeds and congestion are common due to increase of estrogen

Mouth/gums: may be hyperemic and swollen

Neck - look for symmetry, lumps, pulsation. Have patient take sips of H2O while palpating thyroid, may enlarge due to glandular tissue hyperplasia and vascularity

Extremities - arms and hands - erythema in hands and palms due to increased blood volumes

vascular spiders on arms and chest - more prevalent with white women than black.

Check deep tendon reflexes - brachio radialis, quadriceps

Palpate tibia to detect pitting 0-4 scale for edema

Thorax and lungs - observe resp efforts, osculate breath sounds

Heart - palpate max impulse - PMI, pt to lean forward - exhale, auscultate heart

Breast/nipples - symmetry, color, striae and venous pattern, nipples enlarge an erect and darken. Montgomery Tubercles. Palpate breasts - normal for there to be tenderness and nodules. Squeeze nipple between index and thumb - check for discharge

Abdomen - umbilicus may appear level or protrude, peristalsis slows, BS decrease, palpate all quadrants moving clockwise

Genitalia - lathotomy position. Check for enlargement of labia and clitoris, vaginal walls relax during pregnancy and look bluish with deep rugae. Inspect color and shape of cervix.

Nulliparous - circle shape hole, Parous - line shape. Ovaries should be almond shaped and non tender. Pelvis broadens in preparation for delivery

Ischial spines - blunt

Pelvic walls - soft

Sacrospinal ligament - 4-5 cm long

sacrum - concave and hollow

coccyx - may move

Blood tests : Blood typing, Hemoglobin, hematocrit, Rh factor, rubella titer

Urine tests: UA and others PRN

Third trimester:

-BP will increase after falling in 2nd trimester

-wt and VS - compare to initial

-changes due to increased size of uterus, waddle, shoulders back

-check for edema, ankle clonus (jerking)

-reflexes and dorsoflex

-thorax widens at base

-resp rate may increase as fetus pushes on diaphragm

-systolic murmur - increase blood volume up to 50%

-colostrum - discharge from nipples - clear to yellow then cloudy

- striae - stretch marks

-pubis to fundus - measurements should equal gestation weeks

-palpate abdomen - relaxation and tension

-Lie - relationship of mothers spine to that of fetus

longitudinal - spine to spine

transverse - perpendicular

oblique- angle between perpendicular

Presentation:

- cephalic - head first

-breach - butt first

-shoulder

-compound - more than one

Position:

landmarks on presenting part - O (occipital)

side of pelvis landmark faces - L (left)

direction of landmark faces in pelvis - P (posterior)

Leopolds maneuver - face client, determine lye, presentation, position

FHR- fetal heart rate = 160-170 bpm in early pregnancy

110-160 near term