Key Takeaways
- Naegele's Rule calculates EDD: First day of LMP minus 3 months plus 7 days (assumes 28-day cycle with ovulation on day 14)
- GTPAL documents obstetric history: Gravida (total pregnancies), Term births, Preterm births, Abortions/miscarriages, Living children
- Folic acid 400 mcg daily before conception and during first trimester prevents neural tube defects (spina bifida, anencephaly)
- Warning signs requiring immediate evaluation include vaginal bleeding, severe headache, visual changes, epigastric pain, and decreased fetal movement
- First trimester discomforts (nausea, fatigue, breast tenderness) differ from second trimester (heartburn, constipation, hemorrhoids) and third trimester (dyspnea, edema, back pain)
Antepartum Care Overview
Antepartum care encompasses all nursing care during pregnancy, from conception to the onset of labor. The goals are to monitor maternal and fetal well-being, provide anticipatory guidance, and identify complications early.
Dating the Pregnancy
Naegele's Rule
Naegele's Rule calculates the Estimated Date of Delivery (EDD):
First day of Last Menstrual Period (LMP) - 3 months + 7 days = EDD
Example
LMP: March 15, 2026
- March 15 minus 3 months = December 15
- December 15 plus 7 days = December 22, 2026
Important Assumptions
- Regular 28-day menstrual cycle
- Ovulation on day 14
- Accurate LMP date
If LMP is uncertain, ultrasound dating (most accurate in first trimester) is used.
Pregnancy Duration
- 40 weeks (280 days) from LMP
- 38 weeks from conception
- Term: 37-42 weeks
- Preterm: Before 37 weeks
- Post-term: After 42 weeks
GTPAL: Obstetric History
GTPAL documents a woman's complete pregnancy history:
| Letter | Meaning | Description |
|---|---|---|
| G | Gravida | Total number of pregnancies (including current) |
| T | Term | Births at 37+ weeks |
| P | Preterm | Births at 20-36 weeks |
| A | Abortions | Losses before 20 weeks (spontaneous or elective) |
| L | Living | Number of living children |
Example
A woman pregnant for the fourth time with two living children born at term, one preterm birth (deceased), and one miscarriage at 10 weeks:
G4 T2 P1 A1 L2
Exam Tip
Current pregnancy counts in the Gravida (G) but NOT in T, P, or A until delivery occurs.
Prenatal Nutrition
Key Nutritional Requirements
| Nutrient | Recommendation | Purpose |
|---|---|---|
| Folic Acid | 400-800 mcg daily | Prevents neural tube defects |
| Iron | 27 mg daily | Supports increased blood volume |
| Calcium | 1,000 mg daily | Fetal bone development |
| Protein | 60-75 g daily | Tissue growth |
| Calories | +300 kcal/day (2nd-3rd trimester) | Energy needs |
Folic Acid
- Begin BEFORE conception (ideally 1-3 months prior)
- Continue through first trimester minimum
- Prevents neural tube defects (spina bifida, anencephaly)
- Found in fortified cereals, leafy greens, legumes
Foods to Avoid
| Food | Reason |
|---|---|
| Raw/undercooked meat, fish | Bacterial/parasitic infection |
| High-mercury fish (shark, swordfish, king mackerel) | Fetal neurotoxicity |
| Unpasteurized dairy/juice | Listeria risk |
| Deli meats (unless heated) | Listeria risk |
| Raw eggs | Salmonella risk |
| Alcohol | Fetal alcohol spectrum disorders |
Prenatal Discomforts by Trimester
First Trimester
| Discomfort | Management |
|---|---|
| Nausea/Vomiting | Small, frequent meals; avoid empty stomach; ginger; vitamin B6 |
| Fatigue | Rest when possible; adequate sleep; iron levels checked |
| Breast tenderness | Supportive bra |
| Urinary frequency | Normal; rule out UTI if painful |
Second Trimester
| Discomfort | Management |
|---|---|
| Heartburn | Small meals; avoid lying down after eating; antacids as approved |
| Constipation | Increase fluids, fiber, activity |
| Hemorrhoids | Fiber, fluids, sitz baths, witch hazel |
| Leg cramps | Stretch; calcium/magnesium balance |
Third Trimester
| Discomfort | Management |
|---|---|
| Dyspnea | Upright positioning; small meals |
| Edema | Elevate legs; avoid prolonged standing; assess for preeclampsia |
| Back pain | Good posture; supportive footwear; pelvic tilt exercises |
| Braxton Hicks | Hydration; rest; distinguish from true labor |
Warning Signs in Pregnancy
Teach patients to report immediately:
DANGER Signs Mnemonic
- D - Dysuria with fever
- A - Abdominal pain (severe)
- N - Nausea/vomiting (severe, persistent)
- G - Gush of fluid (ruptured membranes)
- E - Edema (face/hands - preeclampsia)
- R - Reduced fetal movement
Additional Warning Signs
| Sign | Possible Condition |
|---|---|
| Vaginal bleeding | Placenta previa, abruption, miscarriage |
| Severe headache | Preeclampsia |
| Visual changes (blurring, spots) | Preeclampsia |
| Epigastric pain | Preeclampsia (HELLP syndrome) |
| Temperature >100.4°F (38°C) | Infection |
| Decreased fetal movement | Fetal distress |
Fetal Assessment
Fetal Heart Rate (FHR)
- Normal range: 110-160 bpm
- First heard with Doppler at 10-12 weeks
- Fetoscope audible at 18-20 weeks
Quickening
- First fetal movement felt by mother
- Primigravida: 18-20 weeks
- Multigravida: 16-18 weeks
Kick Counts
- Begin at 28 weeks
- Goal: 10 movements in 2 hours (varies by method)
- Decreased movement = needs evaluation
Prenatal Visits
Schedule
| Gestational Age | Visit Frequency |
|---|---|
| 0-28 weeks | Every 4 weeks |
| 28-36 weeks | Every 2 weeks |
| 36-40 weeks | Weekly |
Standard Assessments Each Visit
- Weight
- Blood pressure
- Urine (protein, glucose)
- Fundal height
- Fetal heart rate
- Fetal movement inquiry
Using Naegele's Rule, calculate the EDD for a woman whose LMP was June 10, 2026.
A woman is currently pregnant for the third time. She has one child born at 39 weeks and had one miscarriage at 12 weeks. What is her GTPAL?
A pregnant client at 32 weeks reports sudden swelling of her face and a severe headache. The nurse recognizes these as potential signs of: