Guide — Maternal-Newborn
Pregnancy Assessment Basics
Accurate assessment during pregnancy begins with understanding obstetric history terminology and the expected physiologic changes of pregnancy. This guide covers GTPAL notation, prenatal visit priorities, maternal assessment findings, and NCLEX-focused nursing considerations.
10 min read · Maternal-Newborn
Educational use only. Obstetric assessment and management vary by provider, facility, and patient presentation. Always follow current evidence-based guidelines and institutional protocols. This guide reflects general principles for nursing students and NCLEX preparation. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
Prenatal care is one of the most effective preventive health interventions in nursing practice. Early and regular assessment enables identification of risk factors, monitoring of fetal development, and timely management of complications that could threaten maternal or fetal wellbeing.
Nurses play a central role in obstetric history taking, patient education, and ongoing assessment throughout each trimester. Understanding standardized terminology and expected versus abnormal findings is essential for safe maternal-newborn practice and the NCLEX.
Obstetric History
Obstetric history is documented using standardized terminology. Gravida and Para provide a concise summary; GTPAL provides more detail about pregnancy outcomes.
Gravida / Para
GTPAL Breakdown
GTPAL Example:
A woman who has had 3 pregnancies — one full-term delivery, one preterm delivery (both children living), and one miscarriage — and is currently pregnant is documented as: G4 T1 P1 A1 L2
Note: A multiple gestation (twins, triplets) counts as one pregnancy (one gravida) but increases para by one for each delivery, not each infant.
Estimated Due Date (EDD)
The estimated due date (EDD), also called estimated date of confinement (EDC), is calculated at approximately 40 weeks from the last menstrual period (LMP).
Nägele's Rule:
EDD = First day of LMP − 3 months + 7 days + 1 year
Example: LMP = June 10 → EDD = March 17 (following year)
- Ultrasound (especially first trimester) is the most accurate method of dating
- Term pregnancy: 37 0/7 to 41 6/7 weeks
- Early term: 37–38 6/7 weeks; full term: 39–40 6/7 weeks; late term: 41–41 6/7 weeks
- Preterm: less than 37 weeks; post-term: 42 weeks or beyond
Prenatal Visit Schedule
| Gestational Age | Visit Frequency | Key Assessments |
|---|---|---|
| Weeks 1–28 | Every 4 weeks | Weight, BP, urine screen, fundal height, FHR, labs (first visit) |
| Weeks 28–36 | Every 2 weeks | GBS screen, GDM screen (24–28 wks), fetal position, NST if indicated |
| Weeks 36–birth | Weekly | Cervical assessment, fetal station, GBS culture result, birth plan |
Common Physiologic Changes
Pregnancy produces significant physiologic adaptations across all body systems. Nurses must distinguish normal pregnancy changes from pathologic findings.
Cardiovascular:
- Blood volume increases 40–50%; cardiac output increases 30–50%
- Physiologic anemia due to dilution (hematocrit may drop to 32–34%)
- Heart rate increases by 10–15 bpm
- BP typically decreases in the first/second trimester, rises toward baseline in third trimester
- Supine hypotensive syndrome: aortocaval compression in late pregnancy — position left lateral decubitus
Respiratory:
- Tidal volume increases; respiratory rate unchanged or slightly elevated
- Progesterone-driven mild respiratory alkalosis is normal
- Diaphragm elevation by uterus causes functional residual capacity decrease
Renal/GI:
- GFR increases; renal glucosuria may occur without hyperglycemia
- Nausea/vomiting (morning sickness) peaks at 6–12 weeks, resolves by 16–20 weeks for most
- Heartburn, constipation, and hemorrhoids common due to smooth muscle relaxation and GI displacement
Musculoskeletal:
- Relaxin causes ligament laxity — increased risk of falls and round ligament pain
- Lordosis increases to compensate for shifting center of gravity
Maternal Assessment Findings
Fundal height measurement:
- At 12 weeks: fundus at symphysis pubis
- At 16 weeks: fundus midway between symphysis and umbilicus
- At 20 weeks: fundus at umbilicus
- After 20 weeks: fundal height in cm ≈ gestational age in weeks (±2 cm)
Fetal heart rate monitoring:
- Normal FHR: 110–160 bpm
- Doppler audible by 10–12 weeks; fetoscope by 18–20 weeks
- Quickening (fetal movement perceived by mother): 16–20 weeks (earlier in multiparous women)
Weight gain recommendations (ACOG):
- Underweight (BMI <18.5): 28–40 lbs total
- Normal weight (BMI 18.5–24.9): 25–35 lbs total
- Overweight (BMI 25–29.9): 15–25 lbs total
- Obese (BMI ≥30): 11–20 lbs total
Nursing Priorities
- Obtain complete obstetric history at initial prenatal visit; document GTPAL accurately
- Assess blood pressure at every prenatal visit — new hypertension after 20 weeks warrants urgent evaluation
- Monitor for danger signs: severe headache, visual changes, RUQ pain, rapid weight gain, decreased fetal movement, vaginal bleeding
- Screen for gestational diabetes (1-hour glucose challenge test at 24–28 weeks)
- Obtain GBS culture at 36 0/7–37 6/7 weeks — positive result requires intrapartum antibiotic prophylaxis
- Educate on fetal kick counts after 28 weeks: report if fewer than 10 movements in 2 hours
Patient Education
Nutrition and supplements:
- Folic acid 400–800 mcg daily (ideally before conception through first trimester) to prevent neural tube defects
- Iron supplementation as recommended; prenatal vitamins throughout pregnancy
- Avoid alcohol, tobacco, recreational drugs, and teratogenic medications
- Limit caffeine to <200 mg/day; avoid raw meats, unpasteurized dairy, high-mercury fish
Activity and safety:
- Moderate exercise generally safe and encouraged; avoid supine position after first trimester
- Seat belt use: lap belt below the abdomen, shoulder belt across the chest and between the breasts
- Report any vaginal bleeding, fluid leaking, severe edema, or decreased fetal movement immediately
NCLEX Pearls
- Gravida counts the current pregnancy — a woman pregnant for the first time is G1 P0
- Para increases only after reaching viability (≥20 weeks), not at delivery of each infant
- Fundal height in cm ≈ gestational age in weeks after 20 weeks
- Normal fetal heart rate is 110–160 bpm; outside this range requires immediate assessment
- Supine hypotensive syndrome (aortocaval compression): position patient left lateral decubitus
- New hypertension ≥140/90 after 20 weeks + proteinuria = preeclampsia until proven otherwise
- GBS-positive mother requires IV penicillin intrapartum — not prenatally
Related Resources
Standards & sources
Fact-checked Jun 20, 2026This page is written to align with American College of Obstetricians and Gynecologists (ACOG) · AWHONN · American Academy of Pediatrics (AAP) — newborn. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →