Editing Maternal and Newborn Nursing (section)

== Terminology and Obstetric History ==

* '''Gravida''' - number of pregnancies, regardless of outcome. '''Para''' - number of pregnancies carried to 20 weeks or beyond, whether the fetus was born alive or not. Para counts ''pregnancies'', not babies, so twins delivered at 36 weeks count as para 1.
* '''GTPAL''' - '''G'''ravida, '''T'''erm births (37 0/7 weeks and beyond), '''P'''reterm births (20 0/7 through 36 6/7 weeks), '''A'''bortions or losses before 20 weeks (spontaneous or induced), '''L'''iving children.
* '''Nulligravida''' never pregnant; '''primigravida''' pregnant for the first time; '''multigravida''' pregnant more than once. '''Nullipara''', '''primipara''', '''multipara''' apply the same way to births at 20 weeks or more.
* '''Viability''' is generally discussed around 22 to 24 weeks with neonatal intensive care, though outcomes vary widely by gestational age, weight, and center.

'''Naegele's rule''' estimates the due date: take the first day of the last menstrual period, subtract 3 months, add 7 days, and add 1 year. It assumes a regular 28-day cycle with ovulation on day 14, so it is less reliable with irregular cycles. First-trimester ultrasound dating is more accurate than any calculation.

=== Signs of pregnancy ===

* '''Presumptive''' (subjective, felt by the patient, can have other causes): amenorrhea, nausea and vomiting, breast tenderness, urinary frequency, fatigue, quickening.
* '''Probable''' (objective, observed by an examiner, still not conclusive): positive pregnancy test (hCG can also rise with gestational trophoblastic disease), Goodell sign (cervical softening), Chadwick sign (bluish-violet cervix and vagina), Hegar sign (softening of the lower uterine segment), Braxton Hicks contractions, ballottement, uterine enlargement.
* '''Positive''' (only explainable by pregnancy): fetal heart tones heard by an examiner, fetal movement palpated by an examiner, and visualization of the fetus on ultrasound.

'''Application note.''' A patient can have a positive home test and still not have an intrauterine pregnancy. Any positive test with unilateral pelvic pain, shoulder pain, or bleeding raises concern for ectopic pregnancy and needs urgent evaluation.