Assessment & History
GTPAL, fundal height, urine tests, vaginal exam
Obstetric Assessment
History — Active Labor Signs
- Contractions — abdomen becomes rigid, increased pain, lasting 60-90 secs every 15-20 minutes
- Contractions decrease in duration, increase in frequency/strength as delivery draws closer
- Imminent delivery: contractions 45-60 secs every 2-3 mins
- FHR, complete maternal vital signs
- Expected delivery date: LMP, fundal height, gestational age
- Risk factors: vaginal discharge, infection, fever
GTPAL Obstetric History
G — Gravida
Number of times mother has been pregnant
T — Term
Number of births to term (after 37 weeks)
P — Para
Number of births (twins = only 1 birth)
P — Premature
Births before 23 weeks
A — Abortion
Either spontaneous or therapeutic
L — Living
How many births are living
Fundal Height — MacDonald's Rule
Fundal Height measures the distance in cm from the top of the uterus to the pelvic bone. It correlates into weeks to assess normal fetal growth. Example: 28 cm = approximately 28 weeks gestational age.
Fundal height correlates with gestational age (MacDonald's Rule)
Urine Test Findings
| Test | Normal | Abnormal Finding |
|---|---|---|
| pH | Normal range | Low = excess fluid intake; High = dehydration |
| Protein | Negative | 2+ to 4+: UTI, kidney infection, or PIH |
| Glucose | Negative | Elevated = gestational diabetes or DM |
| Ketones | Negative | Fasting/insufficient carbs; may be destructive to fetus |
Vaginal Examination Findings
- Amniotic membranes: Intact or bulging through cervix
- Cervix: Soft, firm, anterior, posterior
- Effacement: 0%/long and thin to 100%/completely thinned out
- Dilation: 0 cm = closed to 10 cm = complete dilation
- Fetal presentation: Presenting part — can you palpate sutures of the head
- Fetal position: Left, right, anterior, posterior, transverse
- Fetal station: Presenting part in relation to the ischial spines
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