Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COMMUNITY HEALTH NURSING 1

(Individual and Family as Clients)

WILMA N. BERALDE, RM, RN, MAN

Clinical Instructor
NATIONAL SAFE MOTHERHOOD PROGRAM

VISION
For Filipino Women to have full access to Health Services
towards making their pregnancy and delivery safer.

MISSION
Guided by the Department of Health FOURmula One Plus
thrust and the Universal Health Care Frame, the National
Safe Motherhood Program is committed to rational and
responsive policy direction to its local government
partners in the delivery of quality maternal and newborn
health services with integrity and accountability using
proven and innovative approaches.
ANTENATAL CARE SERVICES (FIRST 270 DAYS)
REPUBLIC ACT 11148 “KALUSUGAN AT NUTRISYON NG MAG-NANAY ACT”,
focuses on scaling up the national and local nutrition program through a
strengthened integrated strategy for maternal, neonatal child health and
nutrition in the first one thousand (1,000) days of life.

1. PREGNANCY TRACKING AND ENROLLMENT

TO ANTENATAL CARE (ANC)
ANC is defined as the care provided by skilled health
professionals to pregnant women and adolescent girls to ensure
the best health conditions for both mother and baby during
pregnancy. (WHO, 2016)
DOH RECOMMENDED PRENATAL
(ANC) VISITS
PRENATAL VISITS PERIOD OF PREGNANCY
1ST VISIT As early as possible during
pregnancy
2nd VISIT 2nd trimester (4th, 5th, and
6th months of pregnancy)
3rd VISIT 3rd trimester
Every 2 weeks After 8th month until
delivery
ACTIVITIES DURING PRE-NATAL VISIT:
A. HEALTH HISTORY
It is primarily done to determine obstetric
profile like the Gravida, parity, Term, preterm,
abortion, and living (GPTPAL), Expected Date of
Confinement (EDC), and Age of Gestation
(AOG), and potential risk factors such as:
a. Age <18 years old or >35 years old
b. Height less than 145 cm (4’9”)
c. Multiparous women :having a fourth or more
baby)
ACTIVITIES DURING PRE-NATAL VISIT:

d. One or more of the following: a previous

cesarean section, 3 consecutive miscarriages or
stillborn baby, an/or postpartum hemorrhage.
e. One or more of the following medical
conditions: TB, heart disease, diabetes,
bronchial asthma, or goiter.
THE OB SCORE: GP (TPAL)

GRAVIDITY (Gravida)
Number of times a woman has been pregnant

PARITY (Para)
Number of times a pregnancy has been terminated
resulting in the delivery of a fetus or multiple fetuses
with a gestational age of 20 weeks or more, or does not
meet the criteria for an abortus, regardless if the child
was alive or stillborn.
Abortus Criteria:
1. Age of Gestation less than 20 weeks
2. Less than 500 grams
3. Less than 25 cm in height
THE OB SCORE: GP (TPAL)
TPAL
Term-Number of pregnancy delivered at 37 weeks or more
Preterm-Number of pregnancy terminated at 20 weeks or
more, but less than 37 weeks
Abortion-Number of pregnancy terminated either at 20
weeks, or has resulted in a fetus with a weight
of less than 500 grams or height less than
25cm
Live-Number of children currently alive
SAMPLE

A mother has 2 living children, she is

currently pregnant on her 3rd baby, she
has no abortion nor pre term babies
delivered.

G3P2 (2002)
SAMPLE

A mother has 5 living children, she has

an abortion during her 2nd pregnancy at
8 weeks, and no pre term babies
delivered.

G6P5 (5015)
SAMPLE

 A mother has 4 total pregnancies, 2

term deliveries, 1 preterm delivery, 1 
Miscarriage, and has 4 living
children

G4P3 (2114)
4 total pregnancies, 2 term deliveries, 1 preterm
delivery (Twin Gestation), 1 Miscarriage, 4 living
children
SAMPLE

4 pregnancies, 1 term birth, 1

premature birth, 2 abortions, 2 living
children

G4P2 (1122)
ESSENTIAL & VITAL COMPUTATIONS
LAST MENSTRUL PERIOD (LMP)
- First day of the patient’s last menstruation
- Most reliable way of getting the gestational age of pregnancy granted
that menstrual period is regular and the woman is sure of LMP.

GESTATIONAL AGE (AOG)

- Measured from the 1st day of the last menstrual period (LMP);
expressed in completed days or weeks
- 1st day of LMP=day 0 (not counted)

CLASSIFICATIONS
- PRE-TERM: less than 37 completed weeks or less than 259 days
- TERM: 37-42 weeks (259-293 days)
- POST-TERM: more than 42 weeks (more than 294 days)
COMPUTING THE AGE OF GESTATION (AOG)

1. Get the sum of all the days (28,29,30 or 31) of all the months from the date of the
LMP to the date you are finding.

Example: Upon inquiry, KB said that her last day of menses is on February 9, 2020. Her
menstrual period lasted for five days.

Date of Consult: August 13, 2020

LMP: February 5, 2018

February : 28-5 = 23
March : 31
April : 30
May : 31
June : 30
July : 31
August : 13
Total : 189 days
COMPUTING THE AGE OF GESTATION (AOG)
2. Divide the sum by 7 (number of days in week).
The quotient is the AOG.
Example:
189 / 7 = 27
AOG = 27 weeks
SAMPLE

Upon inquiry, Mrs. D said that her last day of menses is on March 23, 2021. Her
menstrual period lasted for six days.

Date of Consult: August 22, 2021

LMP: March 18, 2021

March : 31-18=13
April : 30
May : 31
June : 30
July : 31
August : 22
Total : 157 days
157 / 7 = 22
AOG = 22 weeks and 3 days
SAMPLE
Upon inquiry, Mrs. A said that her last day of menses is last November 2, 2020.
Her menstrual period lasted for four days.

Date of Consult: May 22, 2021

LMP: October 30, 2020

October : 31-30=1
November : 30
December : 31
January : 31
February : 28
March : 31
April : 30
May : 22
Total : 204 days

204 / 7 = 29
AOG = 29 weeks and 1 day
EXPECTED DATE OF DELIVERY/CONFINEMENT (EDD/EDC)
- Date in which pregnancy is expected to be safely terminated, usually at 40
weeks of pregnancy

NAEGEL’S RULE is one of the most commonly used formula in computing EDC
- Subtract 3 from the months and add 7 to the days (-3, +7)

1. Subtract 3 months from the LMP and add 7 days.

Example: LMP – April 5, 2021
04 (months) 05 (days)
-3 +7
-------------------------------
1 12
EDC is January 12, 2022

JAN – MAR ( +9, +7)

APR – DEC ( -3, +7, +1)
EXPECTED DATE OF DELIVERY/CONFINEMENT (EDD/EDC)
2. If the subtraction of 3 from months is 0 or less, count back 3 months from the
LMP, to get the month.
Example: LMP – 02/26/2021
02 26 Count back:
Nov (3) this is your month
-3 +7
Dec (2)
--------------- Jan (1)
11 33 Feb (month of LMP)

3. If after adding 7 to the days and its over the number of days for that particular
month, adjust your EDC accordingly.
Example: LMP – 02/26/2021
02 26 Since November has 30 days, we subtract 30 days to 33, getting 3. Those
-3 +7 30 days are carried over to the month so we can move to December
-------------
11 (33-30 days in Nov = 3) 12/3/2021
EXAMPLE:

1) LMP – December 5, 2020

12 5
-3 +7
9 12, 2021

EDC – September 12, 2021

2. LMP – June 29, 2021

6 29
-3 +7
3 36
36 – 30 = 6
3+1=4

EDC – April 6, 2022

ACTIVITIES DURING PRE-NATAL VISIT:
B. PRENATAL ASSESSMENT
The physical examination includes GPTPAL,
EDC, AOG, weight and height, fundic height
measurement, Leopold’s Maneuver, fetal heart
beat and fetal movement. Likewise, laboratory
examinations are conducted like CBC with
platelet, blood typing and Rh factor
determination, urinalysis (Benedict’s sugar and
acetic acid tests-albumin).
ACTIVITIES DURING PRE-NATAL VISIT:
B. PRENATAL ASSESSMENT

Danger signs of pregnancy:

- Headache
- Blurring of vision
- Dangerous fever (>38 C)
- Severe DOB
- Abdominal pain
- Burning on urine
- Vaginal bleeding
LEOPOLD’s MANEUVER
- It is essential to perform Leopold’s Maneuver on pregnant women
primarily to determine the position of the fetus. Done on an empty
bladder in supine position.
FIRST MANEUVER (FUNDAL GRIP)
- Palpate upper abdomen with both hands to
determine which FETAL POLE OCCUPIES THE
FUNDUS.
Cephalic – Buttocks is palpated (softer, symmetric)
Breech – Head is palpated (hard, round)
Transverse – Shoulder and limbs are palpated
(small, bony processes, moves in upon palpation)
SECOND MANEUVER
(UMBILICAL GRIP)
- Place both hands on either side of the
abdomen. With one hand being stationary, the
other hand palpates the side of the abdomen.
This procedure is done on both sides to
determine LOCATION OF THE FETAL
LIE/BACK (hard, resistant vs. small, irregular,
mobile) that is essential in determining location
of fetal heart tone (FHT).
THIRD MANEUVER
(PAWLIK GRIP)
- Grasp the lower portion of abdomen just
above the symphysis pubis with the thumb and
fingers off the right hand. Validates the findings
of the first maneuver to determine
PRESENTATION and ENGAGEMENT
(immovable).
FOURTH MANEUVER
(PELVIC GRIP)
- Only maneuver that requires the examiner to
face the patient’s feet. Examiner faces the
mother’s feet and, with the tips of the first
three finger of each hand, exerts deep pressure
in the direction of the axis of the pelvic inlet in
order to determine DESCENT.
ACTIVITIES DURING PRE-NATAL VISIT:
C. BIRTH PREPARATION AND EMERGENCY PLANS

Basic contents of birth plan:

- Place of delivery and method of transportation
- Person or personnel to assist during delivery
- Expectations during labor and delivery
- Materials to prepare and estimated cost of
delivery
- Possible blood donors and where the mother
will be referred in case of emergency
ACTIVITIES DURING PRE-NATAL VISIT:

2. DIPTHERIA TETANUS
TOXOID IMMUNIZATION

3. CONSUMPTION OF IODIZED
SALT
DOH RECOMMENDED TETANUS DIPTHERIA
IMMUNIZATION FOR WOMEN
Percentage of Duration of
Vaccine Schedule
Protection protection
As early as possible
Td1
during first pregnancy
4 weeks after the first dose
Td2 within the same pregnancy
80% 3 years

Td3 6 months after Td2 95% 5 years

Td4 1 year after Td3 99% 10 years

Td5 1 year after Td4 99% Lifetime

ACTIVITIES DURING PRE-NATAL VISIT:
4. MICRONUTRIENT AND MACRONUTRIENT
SUPPLEMENTATION

A. Iron Deficiency Anemia

B. Vitamin A Deficiency
C. Iodine Deficiency Disorder
d. Macronutrient Supplementation. Calcium
supplementation
RECOMMENDED DOSE OF IRON AND
FOLIC ACID SUPPLEMENTATION

TARGET PREPARATION DOSE/DURATION

Pregnant women 60 mg elemental iron 1 tab/day for 6 months or
with 400mcg folic acid 2 tabs/day if prenatal
consultation starts on the
2nd and 3rd trimester of
pregnancy
Lactating women 60 mg elemental iron 1 tab/day for 3 months or
with 400mcg folic acid 90 days
RECOMMENDED DOSE OF IODINE SUPPLEMENTATION

TARGET PREPARATION DOSE/DURATION

Children of school age 200mg of iodized oil 1 cap per year
capsule
Women 15-25 years 200mg iodized oil 1 cap per year
old capsule
Adult males 200mg iodized oil 1 cap per year
capsule
RECOMMENDED DOSE OF VITAMIN A FOR
WOMEN
TARGET PREPARATION DOSE/DURATION
Pregnant women 10, 000 IU 1 cap 2x/week (4
months until delivery)
Lactating women 200,000 IU 1 cap once after
delivery (may be
given within 4 weeks
RECOMMENDED DOSE OF CALCIUM after delivery)
SUPPLEMENTATION
TARGET PREPARATION DOSE/DURATION
Pregnant women 1.0-2.0 g elemental Three divided doses
calcium
ACTIVITIES DURING PRE-NATAL VISIT:
5. EARLY IDENTIFICATION AND MANAGEMENT OF
NUTRITIONALLY AT-RISK PREGNANT CLIENT

6. Counselling on maternal nutrition, breastfeeding and

rooming-in, appropriate infant and young child feeding
practices.

7. Assessment of risk for parasitism and provision of anti-

helminthic medicines.
ACTIVITIES DURING PRE-NATAL VISIT:
8. Provision of oral health services including oral health
assessment

9. Counselling on proper handwashing, environmental

sanitation and personal hygiene.

10. Counselling on nutrition, smoking cessation, and

adoption of healthy lifestyle practices.

11. PhilHealth enrolment and linkages to facility and community-

based health and nutrition workers and volunteers.
ACTIVITIES DURING PRE-NATAL VISIT:
12. Social welfare support.

13. Maternity protection during pregnancy.

14. Counselling and support to parents and caregivers on

parent/caregiver-infant/ child interaction for responsive
care and early stimulation for early childhood
development.

15. Provision of counselling and psychological support to

parents and caregivers.
INTRAPARTAL SERVICES
The DOH advocates facility based delivery to ensure safe labor, availability
of intrapartum interventions and to safeguard the welfare of women and
newborns.

1. Antenatal Corticosteroids. These medications are

given to all pregnant women who are at risk for preterm delivery
(labor within 24-34 weeks AOG), or has any of the following:
- Antenatal hemorrhage or bleeding
- Hypertension
- Preterm rupture of membranes

Two corticosteroids are given: Betamethasone 12 mg intramuscularly every 24 hrs for

2 doses or Dexamethasone 6mg (1.5ml) intramuscularly every 12 hours for 4 doses.
INTRAPARTAL SERVICES
2. Essential Intrapartal Newborn Care (EINC)
3. Adherence to couple’s birth, breastfeeding and rooming-in plans.
4. Provision of mother-friendly practices during labor and delivery
5. Monitoring of the progress of labor and the well-being of both the
mother and the child and provision of interventions to health issue
that may arise.
6. Identification of high-risk newborns that will be delivered.
7. Coverage and utilization of PhilHealth benefit packages for
maternal care.
8. Nutrition counseling and provision of nutritious food and meals at
the facility.
9. Provision of lactation management services to support
breastfeeding initiation and exclusive breasfedding for 6 months.
INTRAPARTAL SERVICES
10. Counseling on proper hand washing, environmental sanitation
and personal hygiene.
11. Counseling on and utilization of modern methods of FP and
access to reproductive health care services.
12. Maintenance of nonseparation of the mother and her newborn
and rooming-in for early breastfeeding initiation.
13. Assurance of women and child-friendly spaces during calamities,
disasters, and other emergencies.
14. Provision support to fathers and caregivers.
15. Counseling and support to parents and caregivers on
parents/caregiver-infant/child interaction for responsive care and
early stimulation for early childhood development.
POSTPARTAL SERVICES
1. POSTPARTUM VISIT
1ST VISIT – within 24 hours
2nd VISIT – within one week after delivery

2. MICRONUTRIENT SUPPLEMENTATION
Vitamin A – 200,000 IU/cap 1 cap within 4
weeks after delivery
Iron and folate – 60/400 ug/tab 1 tablet for
3 months or 90 days.
POSTPARTAL SERVICES
3. Birth Registration.
4. Lactation support and counselling from birth up to 2 years
and beyond.
5. Nutrition assessment and counselling to meet the demands
of lactation in health facilities and workplaces.
6. Identification and management of malnutrition of
chronically energy deficient (CED) and nutritionally-at-risk
postpartum and lactating women.
7. Organization of community-based mother support groups
and peer counsellors for breastfeeding in cooperation with
other health and nutrition workers.
POSTPARTAL SERVICES
8. Lactation breaks for women in workplaces.
9. Availability of lactation stations in workplaces.
10. Organization of breastfeeding support groups in workplaces.
11. Provision of micronutrient supplements including iron, folic
acid, vitamin a and other micronutrients deemed necessary.
12. Promotion of consumption of iodized salt and foods fortified
with micronutrients deemed necessary.
13. Provision of oral health services.
14. Counselling on, and utilization of, modern methods of FP and
access to reproductive health care services (RA No. 10354).
15. Social welfare support to improve access to health and
nutrition services.
POSTPARTAL SERVICES
16. Assurance of women-friendly and child friendly spaces where
mothers and their infants will be able to continue breastfeeding
during calamities, disasters and other emergencies.
17. Provision of support to fathers and caregivers.
18. Counselling and support to parents and caregivers on
parent/caregiver-infant/child interaction for responsive care, and
early stimulation for early childhood and development.