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 pregnant Multigravida: more than one pregnancy Parity: the client communicates outcome of previous pregnancies GTPAL : 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 induced L: 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