Maternal Nursing Flashcards
What causes menstruation?
Drop of Estrogen and Progesterone Level.
-Thinnest Endometrium
-Just after Menstruation
Menstrual/Sloughing off
-6th to 14th day
-Thickest Endometrium
Proliferative
Hormone that Increases Progesterone Level
LH
-6th to 14th day
-Thickest Endometrium
Proliferative
Ovulation occurs (Luteal Phase)
Secretory
Period just before menstruation
Ischemic
SEQUENCE OF MENSTRUATION
M-P-S-I
Menstrual/Sloughing off
Proliferative
Secretory
Ischemic
During menstruation what hormones decreases?
estrogen & progesterone level
During ovulation what hormones increases?
Estrogen & progesterone level
average number of days of Menstruation
5 Days
In a 28th cycle the first day of menstruation is on ?
the 28th.
What causes ovulation?
LH which increases Progesterone
1 day is the length of ovulation which occurs on the ____ for 28th cycle.
14th day
OVULATION preceeded by ____.
OVULATION preceeded by MENSTRUATION.
Mentruation occurs when fertilization did not happen
good
Women has ____ovum
300
how many ovum per month is being released?
1ovum ; 2 ovum= twins;3 =triplets
Menstruation occurs on the ___days after ovulation.
14 days
The length of menstrual cycle is depedent on the length of
PROLIFERATIVE PHASE
Bestime to fertilize an ovum
1 day before up to 2 days after ovulation
-No sex 5 days before and 3 days after ovulation.
-Sperm 3 days + 2; Egg 1 day+2.
-Sperm can survive for 3 days or 72 hours.
Calendar Method
-Clear and strectchable
-Spihnbarkheit sign
-No sex 4 days before and 3 days after ovulation.
CERVICAL MUCOUS (BILLING’S METHOD)
-High Progesterone level
-Thermogenic
-It drop slightly before ovulation due to high estrogen
-Rises during ovulation due to high estrogen & progesterone
-No sex 3-4 days after ovulation
BASAL BODY TEMPERATURE
-Safest natural method
-Combination of Cervical mucous + BBT
*Clear Mucuos + ↑BBT
-No sex 3-4 days after ovulation
SYMPATHOTHERMAL
-withdrawal
-Least effective natural method
COITUS INTERRUPTUS
EFFECTIVE METHOD TO PREVENT STDS:
ABSTINENCE- 0% Chances
MONOGAMOUS RELATIONSHIP
CONDOM- Artificial
-Widest portion of fallopian tube
-Site of fertilization
-Common site of Ectopic Pregnancy
Ampulla
-Site of BTL (Immediate sterility)
Isthmus
-site of implantation
-Upper portion: FUNDUS
-Body portion: CORPUS
-Lower portion: CERVIX
Uterus
sperm & egg joins
Fertilization
sperm & egg divides into 2 haploid cells
Meiosis
TYPES OF CHROMOSOMES: Race
GENOTYPE
TYPES OF CHROMOSOMES:Blood type
SEROTYPE
TYPES OF CHROMOSOMES: Physical Appearance
PHENOTYPE
TYPES OF CHROMOSOMES:
-DNA structure
-Picture breakdown of chromosomes
-Traits (Behaviour)
-Hereditary (Genetics
KARYOTYPE
Pt understand the cervical/billing method if she respond
“I feel wet — during ovulation” &
“I feel dry —-during menstruation”.
1st sex
Coital Debut
normal number of chromosomes
46
normal pairs of chromosomes
23
determines sex
(X) Male sperm- Fast; but died faster
SPERM/MALE
What chromosomes if being used during DNA Testing?
KARYOTYPE.
Slow; died last
(Y) Female sperm
Cause: of h-mole
Degeneration of Blastocysts
S/sx: H-mole
High (+) HCG >2months
(-) FHB
(-) Fetal outline
Hyperemesis Gravidarum/ Excessive Nausea & Vomiting
Grape/Snow like clusters
Rapid abdominal Enlargement
High BP (HPN) 1st trimester
Vaginal Bleeding with Brown vesicles (Fluid fluid) 2nd trimester during ultrasound
Complications of H-MOLE:
-Hyperthyroidism
-Pulmonary Embolism
Plan of care: h-mole
-Avoid pregnancy for atleast 1 year
-D & C until HCG becomes (-)
Contraindicated Meds: h-mole
-Oxytocin- contractions causes pulmonary embolism
Drug of Choice: h-mole
METHOTREXATE
Complication of Methotrexate:
-Bleeding due to low B9 (Folic Acid)
Antidote:
LEUCOVORIN
Treat Megaloblastic anemia (B9 anemia)
DOC for Ectopic pregnancy & H-mole
METHOTREXATE
Contents of amniotic fluid
Fetal Urine
Site of placenta implantation
Decidua Basalis
Placenta is made of?
Chorionic Vili + Decidua Basalis
Degeneration of Blastocyst
H-MOLE
HCG is being replaced by ___ by 3rd month during pregnancy.
HPL
What hormones causes N/V during pregnancy?
HCG
What is the indicator of Pregnancy?
HCG
Hyperemesis Gravidarum for >3months
H-MOLE
Hypertension during 1st month
1mon= h-mole
Hypertension during 2nd month
PIH
Abdominal Enlargement starts at ___ of pregnancy
3rd month
-Basis: LMP (1st day of last menstruation)
-Naegel’s Rule
1.AOG
Naegel’s Rule : January - March
+9month +7day; Same Year
Mittendorf’s Rule
LMP
-3 months + 10 days
example:
Naegel’s rule: April- December
-3month +7day +1yr
Fundic Height in cm
20-36 cm = 20-36 weeks of pregnancy
*37 weeks: lightening
Purpose: To estimate the gestational Age
McDONALD’S RULE
Measures the fundic height in cm
3.McDONALD’S RULE
McDONALD’S RULE: AOG Months
**starts on 5th month
**Void
**Dorsal Recumbent position
Fundic Ht(cm) x2/7
McDONALD’S RULE: AOG Weeks
Fundic Ht(cm) x 8/7
**starts on 5th month
**Void
**Dorsal Recumbent position
-locates the fundic Height: Fingerbreadth
BARTHOLOMEW’S RULE
**Void (Fetal height ↑)
**Dorsal Recumbent position
BARTHOLOMEW’S RULE: 2 weeks before & 2 weeks after
EDC/EDD
BARTHOLOMEW’S RULE: >20 weeks;<37 wks
Pre-Term
BARTHOLOMEW’S RULE: 38 weeks-42 weeks
Term
BARTHOLOMEW’S RULE: 38 weeks-42 weeks
Term
BARTHOLOMEW’S RULE: >42 weeks
Full term
QUICKENING
(5months)
QUICKENING :Primigravida
Date of Quickening 5 mons (20 wks) + 4 months = EDB
QUICKENING:Multiparity
Date of Quickening 4 mons (16wks) + 5 months = EDB
-Measures the fetal length in cm.
-Lunar Month (10 month)
HAASE’S RULE
HAASE’S RULE
1-5 divide it by itself;
6-10 divide by 5
1x1 6x5
2x2 7x5
3x3 8x5
4x4 9x5
5x5 10x5
PRODUCTS OF FERTILIZATION
CONCEPTION
2 WEEKS
2 MONTHS
TERM
PRODUCTS OF FERTILIZATION
-Conception to 2 weeks= ZYGOTE
-2 weeks to 2 months= EMBRYO
-2 months to Term= FETUS
**Exactly 2 weeks; Embryo
**Exactly 2 months; Fetus
Johnson’s Rule
-Applicable only in cephalic presentation
-determine Fetal head in cm
-if head is engaged or not
FORMULA:
ABOVE THE ISCHIAL SPINE; FLOATING (-) STATION:
FH in cm - 12 X 155g = EFW in grams
BELOW ISCHIAL SPINE, ENGAGED (+) STATION:
FH in cm - 11 X 155g = EFW in grams
Ultrasound
-Measuring biparietal diameter of the head
*What do you call the product of fertilization from 8 weeks up to the time of birth?
FETUS
EMOTIONAL RESPONSES:
D-A-R
Denial
Ambivalence
Regression
1st Trimester (1-13 weeks)
EMOTIONAL RESPONSES:
Acceptance
Fantasy
2nd Trimester (14-27 weeks)
EMOTIONAL RESPONSES:
Fear r/t Labor & Delivery
3rd Trimester (28-40 weeks)
-means pancake
-combination of Chorionic Vili + Decidua Basalis
PLACENTA aka SECUNDINES
Forms placenta
Decidua Basalis
It encapsulates/ cover the fetus
Decidua Capsularis
Remaining portion of placenta
Decidua Vera
Size: PLACENTA
8 inch; 1 inch Thickness
Shape: placenta
Discord
weight of placenta
500 grams (1/2 kgs)
number of Cotyledons of placenta?
15-28 cotyledons (average)
Smooth & Shiny placenta
Schultz
Rough & Dirty placenta
Duncan
PLACENTA aka ______
SECUNDINES
-Blocks harmful substances to the baby, thereby prevent birth defects.
BARRIER
Safest: Antibiotics
Penicillin (Amoxicillin) Pen-G
Harmful Antibiotics:
Tetracycline
Coumadin that Doesn’t cross/enters placenta
Heparin (IV)
Coumadin Crosses Placenta
Coumadin (Warfarin)
Substances that crosses the placenta barrier:
Antibiotics
-Safest: Penicillin (Amoxicillin) Pen-G
-Harmful: Tetracycline
Narcotics (Opiods)
-Morphine Sulfate - CNS depressant
Coumadin (Oral) Anti-coagulant
-Heparin (IV)- Doesn’t cross/enters placenta
-Coumadin (Warfarin)- Crosses Placenta
ILLNESS/DISEASES THAT CROSSES PLACENTA
T-O-R-C-H
ILLNESS/DISEASES THAT CROSSES PLACENTA -Cat waste, Uncooked meat (raw meat), Fresh Goat’s Milk.
TOXOPLASMOSIS
DOC: TOXOPLASMOSIS
Sulfonamides
ILLNESS/DISEASES THAT CROSSES PLACENTA- OTHER INFECTIONS:
Hepatitis B
Syphilis
HIV
ILLNESS/DISEASES THAT CROSSES PLACENTA:
-Vaccine is not given during pregnancy
-Vaccine contains live virus
-Given after delivery and advise not to get pregnant atleast 3 months.
RUBELLA (German Measles)
ILLNESS/DISEASES THAT CROSSES PLACENTA:
-Airborne
-Soiled linens of infected person (Direct Contact)
CYTOMEGALOVIRUS
ILLNESS/DISEASES THAT CROSSES PLACENTA:
-STD
HERPES SIMPLEX VIRUS
DOC:
HERPES SIMPLEX VIRUS
ziclovir
-Somatotrophin
-Causes: GDM
-Stars to produce on 3rd month
-End at delivery of placenta
HPL (Human Placenta Lactogen
-Intrauterine; the baby gets air into placenta.
RESPIRATORY FUNCTION
EXCRETATORY of waste; EXCEPT?
Except MECONIUM
-Intrauterine = Intestine is sterile
DIGESTIVE (GIT) FUNCTION
Administer Vit. K after delivery
-Synthesize In Large Intestine
-prevent bleeding
PLACENTA MUST BE DELIVIERED WITHIN___ MINUTES
3-10 MINUTES (MAXIMUM 30 MINUTES)
> 30 Minutes
Indicates complications
Intervention: >30 Minutes placenta delivery
Report to Physician
SIGNS OF PLACENTAL SEPARATION:
Gushing of Blood
Rising of fundus; abdomen becomes globular
Lengthening of the cord
Rising of fundus; abdomen becomes globular
(CALKIN’S SIGN)
Order of Placental separation?
1st CALKIN’S SIGN
2nd: Lengthening of the cord
3rd: Gushing of Blood
invades the myometrium
A.PLACENTA INCRETA
-Adherent/attacks to myometrium
B.PLACENTA ACCRETA
***Complications:PLACENTA ACCRETA
Abruptio/bleeding(Increta + accreta
Placenta with 2 lobes
C.PLACENTA BIPARTITA
Placenta with 3 lobes
D.PLACENTA TRIPARTITA
Placenta with accessory lobe or extra lobe
E.PLACENTA SUCCENTURIATA
-Umbilical cord is attached to placenta margins.
F.BATTLEDORE PLACENTA
Low-lying placenta
G.PLACENTA PREVIA
Premature separation of placenta
ABRUPTIO PLACENTA
Low lying placenta
PREVIA
Source: PREVIA
External Bleeding
Bright-red bleeding
Painless
(-) fetal distress
Avoid : PREVIA
IE/SEX
Dx test for : PREVIA
by ultrasound
Separation of placenta
ABRUPTIO
Cause: ABRUPTIO
Uterine contraction
During labor
Accreta/Increta
Trauma
Maternal Drug
Source: abruptio
Source:
Internal/concealed bleeding
External dark-red bleeding
Painful
(+) fetal distress
Life-threatening (mother/baby)
Emergency C.S.
TYPES OF PREVIA: CS Delivery
COMPLETE PLACENTA PREVIA
TYPES OF PREVIA: Double Set-up
PARTIAL PLACENTA PREVIA
TYPES OF PREVIA:
-20mm of previa is exposed
-Low lying previa
-NSVD
MARGINAL PREVIA (edge)
aka: Cable, Cord, Measuring Tape, FUNIS
UMBILICAL CORD
Length: UMBILICAL CORD
25 inches; 55 cm
Complications:
Long Umbilical Cord
Cord coil, Loop, Nuchal Cord
Complications:
Short Umbilical Cord:
Abruptio/ Bleeding
Protective structure of placenta:
WHARTON’S JELLY
Blood vessels: UMBILICAL CORD
A-V-A; 2 Arteries; 1Vein
A: unoxygenated
V: oxygenated
Temporary structure:
Ductus Venosus
Ductus Arteriosus
Foramen Ovale
Temporary structure: Bypass liver
Ductus Venosus
Temporary structure: By pass lungs
Ductus Arteriosus
Temporary structure:By pass lungs
Foramen Ovale
AMNIOTIC FLUID: Source
Fetal Urine
AMNIOTIC FLUID: start Production
3rd Month and low by 9th month
AMNIOTIC FLUID: Amount
500-1000 ml
Oligohydramnios
<500 ml
Polyhydramnios Or Hydramnios
> 1200ml
Cause/Complications: Amniotic fluid
OLIGOHYDRAMNIOS
POLYHYDRAMNIOS
Cause/Complications: Amniotic fluid
-Renal Failure or Renal Agenesis
OLIGOHYDRAMNIOS
Cause/Complications: Amniotic fluid
-TEF (Tracheo-Esophageal Fistula)
POLYHYDRAMNIOS
MANIFESTATION: 3C’s FET
Coughing
Choking
Cyanosis
+
Abdominal Distention
Appearance: amniotic fluid
Clear with fine Streaks of Vernix Caseosa
indicates Meconium Staining
Green-
NORMAL PRESENTATION: due to compression of intestine of the baby during uterine contraction.
Breech
ABNORMAL PRESENTATION: indicates that the fetus is in distress
Cephalic
INTERVENTION: Cephalic meconium staining
Check fetal heartbeat
Emergency CS
test for ruptured BOW (PROM)
FERN TEST (NITRAZINE PAPER)
test for ovulation
↓
Cervical Mucuous
↓
Dried-Up
↓
“Fern-Shape”
↓
Indicates: Ovulation
FERNING TEST/FERN TESTING
Yellow result in nitrazine
Urine (Acidic)
Blue result in nitrazine paper/test
Amniotic Fluid (Alkaline)
Absence of amniotic Fluid.
Fetal Distress
Due to absence of barrier.
Ascending Infection
COMPLICATION OF RUPTURED BOW (PROM)
A.Fetal Distress
B.Cord Proplapse
C.Ascending Infection
PLAN OF CARE: PROM
a)Priority: POC:
-Trendelenburg
-Knee-chest
b)Apply pressure with sterile OS soak with NSS (Saline solution)
c)In case of cord coil/loop
(-) Fetal Distress
-Insert 2 glove fingers & lift cord away from the head (slide the cord)
(+) Fetal Distress
-Clamp & cut the cord (release the cord)
NRSG ALERT: In case of Cord Proplapse
“Never touch the cord with bare hands”
-Measures the fetal serum protein
Increase AFP
Indicates down syndrome (Trisomy 21/ Chromosomal defects
Low AFP
PRE-NATAL CARE
BP Monitoring & Pre-Natal Visit
FREQUENCY OF PREGNANCY: 1-7 Months
Every Month
FREQUENCY OF PREGNANCY: 8-9 Months
Every 2 weeks
FREQUENCY OF PREGNANCY: 10 Months (40 weeks);
EDC= Every Week
FREQUENCY OF PREGNANCY: Post-Term (41-42 weeks)
2x a week
HIGH BP ( HPN)
1st Trimester: indicates?
H-mole/ Molar Pregnancy
HIGH BP ( HPN) 2nd & 3rd Trimester:
PIH; Pregnancy Induced Hypertension
1st sign of PIH
Edema of HAND & FACE
Intervention for PIH
Weight Monitoring every Pre-natal visit
PATTERN OF NORMAL WEIGHT GAIN DURING PREGNANCY
1st Trimester:
1.5 -3 lbs= 1lb/Month
PATTERN OF NORMAL WEIGHT GAIN DURING PREGNANCY
2nd & 3rd Trimester:
10-12 lbs = 1lb/ Week
PATTERN OF NORMAL WEIGHT GAIN DURING PREGNANCY
Full Term: Average Weight Gain
20-30 lbs
-Due to Physiologic Anemia
-High in 30-50% of plasma value
-75%: Plasma (Liquid Portion of Blood)
-25% RBS; Diluted Blood
LOW RBC
Signs of IDA
Same with Physiologic Anemia
4F’s
Fatigue (Tiredness)
Fainting
Forgetfullness + Dyspnea & Tachycardia
Pallor
MANAGEMENT: IDA
Increase Iron Diet
Iron Supplement
URINALYSIS:
(+) Protenuria
(+) Albuminuria
Portenuria & Albuminuria= PIH
URINALYSIS:
(+) Glucosoria
GDM
**Slight Glucosuria- Normal
-due to high progesterone; Due to increase renal Permeability; which then leads to excretion of glucose in urine.
DISCOMFORT -Due to HCG
A.NAUSEA & VOMITING (MORNING SICKNESS)
COMFORT MEASURES: NAUSEA & VOMITING (MORNING SICKNESS)
Best Action: Crackers or Dry Toast in AM
DISCOMFORT: Due to gastric reflux (high HCG) Secondary to pressure of enlarging uterus.
B.HEARTBURN (PYROSIS)
Best Action:HEARTBURN (PYROSIS
Small frequent Feeding
DISCOMFORT:Compression of the intestine by the enlarging uterus.
C.CONSTIPATION
Best action: CONSTIPATION
High Fiber Diet
URINARY FREQUENCY: Early Pregnancy
Compression of bladder
URINARY FREQUENCY: Late Pregnancy
Fetal Lightening
Best Action: URINARY FREQUENCY
Kegel Exercise
DISCOMFORT: Due to decrease backflow of blood to the heart secondary to compression of enlarging uterus.
LEG EDEMA/ VARICOSITIES
Best action: LEG EDEMA/ VARICOSITIES
Leg Elevation (20 mins)
COMPLICATIONS: Shiny-white leg due to overstretching of the skin.
Milk Leg/Phlagmasia/ Alba Dolens:
DISCOMFORT:Due to venous stasis in the lower extremities secondary to compression of uterus.
RISK FOR THROMBUS FORMATION
Best action: RISK FOR THROMBUS FORMATION
Encourage ambulation every 2 hour
COMPLICATION:Compression of vena cava by the enlarging uterus.
SUPINE HYPOTENSION
BEST ACTION: SUPINE HYPOTENSION
Left side-lying position
COMPLICATION: -Due to hypocalcemia secondary to imbalance between calcium & Phosphorus due to bone development.
LEG CRAMPS
Best Action: LEG CRAMPS
Best action:
/Dorsiflexion
Preventive measures:
/Increase Calcium Diet
Bleeding of unknown cause: Ask:
What month are you pregnant?
***(+) Bleeding; what is the 1st Intervention
BEDREST
implantation or pregnancy outside uterus
ECTOPIC PREGNANCY
Common Cause: ECTOPIC PREGNANCY
PID (Pelvic Inflammatory Disease
Inflammation:
Uterus
Fallopian Tube
Common Site: ECTOPIC PREGNANCY
Ampulla
Manifestation:
ECTOPIC PREGNANCY
Severe knife-like pain in the lower abdomen
Lower abdominal pain that radiates to the shoulder
(+) N/V
Cullen’s Sign
- Bluish Discoloration Of Umbilicus
-External Dark-Red Bleeding
-Shock sign= Hypo, Tachy, Tachy, low urine output
-Low HCT
(+) Cullen’s Sign
DOC: ECTOPIC PREGNANCY
DOC: METHOTREXATE
-To abort the pregnancy
-Removal of fallopian tube
Salphingectomy
-Termination of pregnancy before age of viability (<20 weeks)
ABORTION (Miscarriage)
**1st sign of abortion:
Vaginal Spotting
Intentional or by-force which is either illegal or therapeutic.
INDUCED ABORTION
SPONTANEOUS ABORTION:
Common cause:
Chromosomal Abnormality
ABORTION
(+) Spotting
(+) Abdominal cramping
(-) Cervical Dilatation
a)THREATENED
Intervention: THREATENED
BEDREST
abortion:
(+) Spotting
(+)Abdominal Cramping
(+)Cervical Dilataion
INEVITABLE
Intervention of inevitable A.
D & C
Complication of D&C:
-Hemorrhage
-Infection
ABORTION:
-all product is expelled
-No intervention; only emotional support
c)COMPLETE
ABORTION:
-some products are retained
d)INCOMPLETE
-Intervention: INCOMPLETE A.
: D & C
ABORTION: fetal death in uterus
e)MISSED ABORTION
Management:MISSED ABORTION
Induce Labor
(Oxytocin) & Vacuum Extraction
3 or more spontaneous abortion
f)HABITUAL ABORTION
Common cause:HABITUAL ABORTION
INCOMPETENT CERVIX
Management: HABITUAL A.
MCDONALDS & SHIRODKAR
permanent cerlage; suturing= 2-3 months
SHIRODKAR (CS)
-temporary cerlage (suturing) 2-3 months
MCDONALDS (NSVD)
PIH (Pregnancy-Induced Hypertension)
Starts at:?
5th Month (20 weeks)
manifestation of PIH?
Protenuria
IEdema (face/hand)
Hpn
Cause: OF PIH
Induce pregnancy
Cure of PIH
Delivery of Baby/Fetus
Temporary Placenta for 2 months
Corpus Lutean
The nurse is caring for mother, when is the most vulnerable to the teratogens /illness to fetus?
1-2 months -since barrier is not yet formed (3rd month)
stays in the mother’s system/ blood
IV
enters/crosses the placenta
Oral
Lung expansion occurs during the ___ of the baby
1st crying of the baby.
Fine-downy hair
Lanugo
Cheesy-like substance (Protects Skin)
Vernix-Caseosa
Combination of lanugo+ Vernix Caseosa; Swallowed by the baby.
Meconium
Causes GDM
HPL
What month does kidney develops?
1ST MONTH
at what month does kidney functions and produces urine
3rd month
Which of the following enhances the absorption of vit. K?
fats (fat soluble vitmans)
Nurse is caring for mother whose placenta is intact for 8 hours
CALL THE PHYSICIAN!!
=30 Mins. (Max Waiting)
First sign of pregnancy:
Amenorrhea
Indicator of pregnancy:
hcg
H-Mole
GTP
High BP; 2nd tri
Bleeding
High BP; 1st tri
H-Mole
normal physiologic changes during pregnancy:
Edema in lower extremity (LEGS)
“I cant wear my wedding ring”
PIH
What is the most accurate indicator of GDM?
Blood Glucose/ Sugar
fetal lightening- Urinary frequency
3rd Trimester
What causes Amenorrhea
presence of Placenta
Hormones of Pregnancy
PROGESTERONE ABSENCE OF UTERINE CONTRACTION TO MAINTAIN PREGNANCY TILL FULLTERM
Bleeding of unknown cause:
Ask! What month are you pregnant?
Death of fetus after viablity; Termination of pregnancy after age of viability (>20 weeks)
Fetal Demise
Baby is alive during entire pregnancy ; died during delivery.
Stillbirth
High risk for pregnancy
<18 y.o.
>35 y.o.
Ideal age for child bearing
20-30 y.o.
OBSTETRICAL NOTATION
Total # of pregnancy including the present
Gravida
OBSTETRICAL NOTATION
Total number of births, 20 weeks & above irrespective to outocme
Para
OBSTETRICAL NOTATION
-Never got pregnant
Nulli
OBSTETRICAL NOTATION
-1st pregnancy
Primipara
OBSTETRICAL NOTATION
-2 or more pregnancy
Multipara
OBSTETRICAL NOTATION
-5 or more
Grandmulti para
TPALM Scoring:
Term infants: 37 wks & above dead/alive
Preterm infants: 20-36 wks dead/alive
Abortions:
Living Currently:
Multiple Gestation:
