Contents

CHECKLIST 1 – PERFORMING ANTENATAL HISTORY TAKING......................................... 2

CHECKLIST 2 – PERFORMING ANTENATAL ABDOMINAL EXAMINATION, LEOPOLD
MANEUVERS AND AUSCULTATION OF FETAL HEART.......................................................... 5
CHECKLIST 3 – PALPATING UTERINE CONTRACTIONS................................................... 9

1
 CHECKLIST 1 – PERFORMING ANTENATAL HISTORY TAKING

Purpose

 To assess the antenatal woman’s general health and wellbeing

 To provide essential information about previous pregnancies
 To manage medical complications (if any)
 To screen for risk factors that may have a bearing on the progress of the pregnancy and its
outcome
 To conduct antenatal care first visit/booking
 To provide health education and counseling; and advice and preparation of childbirth

Equipment

 Antenatal card
 Antenatal record form

STEP INTERVENTIONS RATIONALES

1 Gather equipment
2 Reviewed any available medical files/records of woman

3 Greet the woman and introduce yourself

4 Draw curtains around the bed Provide privacy for the woman and
show concerns the woman’s cultural
and religious background
5 Place woman in relaxed reclining or sitting position Promotes comfort during booking
6 Explain to the woman what will be done and how she Reduces anxiety and promotes
may cooperate relaxation during the procedure
7 Listen to the woman’s problems and concerns This data yields information about
attentively; and respond to her questions woman’s overall condition. Often,
best database is drawn from
observation
8 Fill the woman’s antenatal card with all the relevant Details information of woman’s
information you gathered from the pregnant woman obstetrical and other related
conditions
9 Perform history taking Information obtained will ease
 Ask/Check all relevant information on the Antenatal antenatal care and management of
Card of the woman woman during pregnancy
a. Personal history (1st Visit)
i. Woman’s name, age, occupation, husband’s name, Demographic characteristic is
address and duration of marriage, potential harmful needed for further obstetric
habits (i.e. smoking) diagnosis, management and care
b. Details of presenting complaints
(1st and Subsequent Visits)
 Fever To find out how exactly symptoms
 Vomiting began, in what setting they arose,
 Vaginal discharge/itching/leaking of watery fluid and how symptoms have evolved
 Vaginal bleeding since initial onset
 Severe headache/blurring of vision
 Difficulty of breathing, palpitations, easy fatigability Knowing mother’s symptoms and
 Severe pain in the abdomen obstetrical disorder/complication is
necessary in assisting the nurse to
 Decreased/absent fetal movement within the last
provide the most effective teaching
day
strategies, client education and
 Generalized swelling of the body, puffiness of the
nursing care
face
STEP INTERVENTIONS RATIONALES
 Reduced urine output or burning on micturation
 Other complaint that makes the woman to visit the
antenatal clinic

If any of the above is positive then take a quick history

and initiate appropriate management. Perform rest of
the history when the pregnant woman is comfortable
c. Menstrual history
i. Woman’s 1st day of her last menstrual period (LMP)
ii. Calculate expected date of delivery (EDD) and
gestational age using either one of the formula:
Formula 1:
EDD = LMP + 9 months and 7 days
OR
Formula 2:
Using Naegele’s rule by taking the first date of the
LMP, subtract 3 months, and add 7 days
Determine the woman’s EDD and
help in providing appropriate
antenatal care
The EDD according to the LMP is
used if:
 The LMP is reliable (the
woman is certain of the first
day of LMP and she has a
regular 28 or 35* day cycle)

E.g.
A woman’s LMP is 2/1/2012. To calculate her EDD,
add 7 days to LMP plus 9 month. Or similarly add 7
days to LMP and subtract 3 months (see
calculation below).
EDD = 2/1/2012 + 9 months + 7 days=9/10/2012
EDD = 2/1/2012 + 3 months + 7 days=9/10/2012

d. Current Obstetric History(1st Visit Only) Provide clear picture of current

pregnancy
 Last Menstrual Period (LMP) Determine the need for routine or
 Any obstetrical complications e.g. pre-eclampsia further investigation that should be
 Any minor discomfort experience by woman e.g elicited
nausea and vomiting
 Any obstetrical complaint e.g vaginal bleeding or
discharge
 Activity of fetal movements (if applicable)
e. Past Obstetric History Provide relevant information of
previous pregnancies, outcomes
and any complications
 Frequency of pregnancy (Gravidity and parity)
 Abortion
 Duration of pregnancy
 Mode of deliveries (Induction/Spontaneous)
 Delivery outcome: Number of living children &
gender
 Birth weight
 Any complication during pregnancy or delivery
 Mode of infant feeding
(Breastfeeding/Bottlefeeding)
 Year of last labor
f. Family medical history Family history screening is
especially important in
reproductive planning and as
generic medicine explain diseases
STEP INTERVENTIONS RATIONALES
 Diabetes mellitus Because certain diseases and
 Hypertension conditions run in families, such as
 Cardiac problem breast and colon cancer, heart
 Multiple pregnancies (Twins) disease, type 2 diabetes,
 Congenital anomalies depression, and thrombophilia
 Other medical disorder (blood clotting conditions). Such
information can better help nurses
managed and care for the woman,
prevent or minimize the problem.
g. Medical Surgical History
 Medical: Any chronic disease like diabetes mellitus, Provides information about what
hypertension, urinary tract infections, heart medical surgical problems the
diseases, viral infection and drug allergies woman has had in the past and
potential problems that might be in
 Surgical: C-section, forceps delivery, breech the woman’s present pregnancy (if
delivery any).

Many medical problems affect

pregnancy; and these
conditions/illness require careful
evaluation and counseling
h. Gynecology History
 Dilatation and curettage (D & C) Provides information about what
 Vaginal repair gynecological problems the woman
 Caesarean section (C-section) has had in the past and potential
 Cervical cerclage problems that might be in the
 Non-Gynecologic operations woman’s present pregnancy (if
any)
i. Family Planning History Establish history of recent
contraceptive use
j. Immunization History Information of immunization status
past and present is essential to plan
 Woman’s tetanus immunization status for further immunization for
 Anti-Tetanus Toxoid (ATT) injection given 16 – 18 pregnant woman.
weeks gestation after quickening is felt
 ATT 2nd. dose is given at 34 weeks gestation. Benefit of vaccination among
pregnant women can protect the
mother from disease and protect the
neonate from disease with passive
maternal antibodies.

Failure to maintain an immune

status to diseases such as
tetanus, can result in serious
consequences.
k. Other
 History of allergies (drugs, foods or others) Provides information of other
 Blood transfusion problems the woman has had (if
 Rh incompatibility any)
 X-ray exposure

SUGGESTED ANTENATAL VISIT:

 Below 28 weeks – once a month
 28 – 35 weeks – every two weeks
 36 weeks and above – every week

More visits may be necessary depending on mother’s condition and needs

CHECKLIST 2 – PERFORMING ANTENATAL ABDOMINAL EXAMINATION,
LEOPOLD MANEUVERS AND AUSCULTATION OF FETAL HEART

Purpose

 To provide information about fetal presentation, position, presenting part, lie, attitude and
descent
 To determine fundal height
 To aid in location of the fetal heart sounds
 To determine the fetal heart rate
 To determine single versus multiple gestation
 To detect any deviation from normal

Equipment

 Pinard stethoscope
 Measuring tape
 Antibacterial Hand Cleaner Sanitising Gel
 Drawsheet

STEP INTERVENTIONS RATIONALES

1 Check the order for procedure and nursing care plan. Obtains specific instruction and or
information.
2 Gather equipment. Provide good organization of
intervention.
3 Greet the woman and introduce yourself.
4 Explain procedure to the woman and the rationale for Awareness of the procedure may
each step as it performed reduce anxiety and promotes
cooperation during the procedure.
5 Instruct the woman to empty the bladder. An empty bladder contributes to the
woman’s comfort during
examination.
6 Draw curtains around the bed. Provide privacy for the patient
7 Perform hand hygiene. Prevents transmission of
microorganisms.
INSPECTION
Position the woman for examination.
 Place woman in dorsal recumbent position, Promotes relaxation of abdominal
supine with knees flexed muscles.
7  Place a pillow under the head for comfort
 Place a small pillow or folded towel under Uterine displacement prevents
woman’s right hip aorto-caval compression, which
could reduce blood flow to the
placenta.
 Have her arms by her sides.
 Drape the woman with a drawsheet. Maintain privacy
 Expose her abdomen from below the breasts Enables visualization of the
to the symphysis pubis. abdomen
Inspect abdomen for the following:
8  Scars, Diastasis reti, Hernia, Linea nigra,
Striae gravidarum, Contour of the abdomen,
State of umbilicus, Skin condition
STEP INTERVENTIONS RATIONALES
9 Determine the fundal height using the ulnar side of the Identify fundus and provides an
palm (2.1) estimate whether fetal growth
corresponds to gestational period
 12 weeks – level of symphysis pubis
  16 weeks – midway between symphysis pubis
and umbilicus
 20 weeks – 1 to 2 finger breadths below
umbilicus
 24 weeks – level of umbilicus
 32 weeks – halfway between umbilicus and
xiphoid process
 36 weeks – at level of xiphoid process
 40 weeks – 2 to 3 finger breadths below the
xiphoid process if lightening occurs
Measure fundal height using measuring tape
 Place zero line of the tape measure on the
10 superior border of the symphysis pubis.
 Stretch the tape across the contour of the The number of centimeters
abdomen to the top of the fundus along measured should be
the midline. approximately 22 to 24 weeks.
Preferably performed after 24
PERFORMING LEOPOLD’S MANEUVERS weeks gestation when fetal outline
can be already palpated.
11 Instruct the woman to relax her abdominal muscles by Reduces stretching and tensions
bending her knees slightly and do relaxation breathing. of abdominal muscle during
procedure.
12 Warms hands by rubbing both palmar surface of your Cold hands can stimulate uterine
hands. contractions and cause discomfort.
13 Rest your hand on the woman’s abdomen lightly while Resting hands on woman’s
reinforce explanation given earlier. abdomen would help her to become
accustomed to your touch and
dissipate muscle tightening.
14 Use flat palmar surface of fingers and not fingertips These techniques aid in gathering
during palpation; and keep fingers of hands together. greatest amount of information with
least discomfort to the
woman.
15 Apply smooth and gentle deep pressure as firm as Provides accurate findings.
necessary.
Perform 1st Leopold’s Maneuver (Fig 2.2a) Determine fetal part lying in the
fundus and presentation

 Stand at the woman’s side and face the Can observe any discomfort and or
woman; and palpate the fundus using both pain experience by the woman
hands. during abdominal palpation.

Determine fundal height.

16  Curve the fingers around the top of the uterus
and feel for the fetal part lying in the fundus.
STEP INTERVENTIONS
 Use the palm, palpate for size, shape and
consistency and mobility of the fetal part in the
fundus.
Perform 2nd. Leopold’s Maneuver (Fig 2.2b)
 Place your hands on either side of woman’s
abdomen about midway between the
symphysis pubis and the fundus.
 Move your hands to the sides of the abdomen
Round, hard, readily, movable part,
ballotable between the fingers of
both hands is indicative of head.
Irregular, bulkier, less firm and not
well-defined or movable part is
indicative of breech. Neither of the
above is indicative of
transverse lie.
RATIONALES
Identify location of fetal back and to
determine position.
17  With one hand in place to steady the uterus, A firm convex, continuously smooth
use the other hand to palpate the opposite side and resistant mass extending from
of the uterus with firm, circular motions breech to neck is indicative of fetal
back. Small knobs, irregular mass,
which move
when pressed is indicative of the
fetal small parts/limbs.
 Repeat the maneuver of opposite side of the Confirm findings.
abdomen
Perform 3rd. Leopold’s Maneuver (Fig 2.2c) or Pawlik’s Determine engagement of
Grip presenting part.
18
 Continue facing the woman, grasp the portion If the fetal head is above the pelvic
of the lower abdomen immediately above the brim, it will be readily movable and
symphysis pubis between the thumb and ballotable.
middle finger of one of your hands.
Perform 4th. Leopold’s Maneuver (Fig 2.2d) Determine the degree of flexion of
fetal head and attitude.
 Face the woman’s feet and place the palmar
surface of your hands on each side of the
woman’s abdomen
 Use both hands and palpate fetal head using This maneuver determines
19 pressing downward gently with your fingertips whether the fetal head is flexed
about 2 inches above the inguinal ligament

If the hands converge around the presenting part, the

head is not engaged.

If the presenting part is engaged, there will be no

mobility. This is indicative of an engaged head.

Omit the 4th maneuver if fetus in breech presentation,.

This maneuver is performed only in cephalic

presentation
FETAL AUSCULTATION USING PINARD
STETHOSCOPE
20 Place the pinard over the convex portion of the fetus Fetal heard sounds heard best over
closest to the anterior uterine wall. fetal back at scapula region in
vertex and breech presentation.
Over chest in face presentation.
21 Listen by pressing in firmly and very gently; and count a
full minute without holding the pinard while the other
hand feel for the mother’s radial pulse.
22 Inform the woman the findings.
23 Tidy the woman’s unit.
24 Wash hands.
25 Document findings and remarks if any.
Figure 2.1 Fundal Height by Weeks Figure 2.2 Leopold Maneuvers
 CHECKLIST 3 – PALPATING UTERINE CONTRACTIONS

Purpose

 To determine whether a contraction pattern is typical of true labor

 To identify abnormal contractions that may jeopardize the health of mother or fetus

Equipment

 Drawsheet
 Partogram form

STEP INTERVENTIONS RATIONALES

1 Greet the woman and introduce yourself.
2 Explain procedure to the woman and the rationale for Awareness of the procedure may
each step as it performed reduce anxiety and promotes
cooperation during the procedure.
3 Assess at least 3 consecutive contractions in a row at
the time the fetal heat rate (FHR) is checked.
 Hourly during latent phase
 Every 30 minutes during active phase and
transition
 Every 15 minutes during second stage of
labour
4 Place fingertips of one hand on the uterine fundus, Contractions usually begin in the
using light pressure. fundus, although the mother usually
feels them in her lower back.

5 Keep fingertips relatively still Fingertips are more sensitive to to

tightening of the uterus.

Constant moving of the hand over

the uterus may stimulate
contractions and give an inaccurate
assessment of their
true pattern.
6 Note the time when each contraction begins and ends Contractions are expected to
increase in frequency, duration and
intensity as labor progresses.
7 Estimate the average intensity of contractions by noting
how easily
8 Report hypotonic contraction if any.
9 Document in the mother’s partogram chart.