2 Obstetrics and gynecologic examination

Question 1

What are the gynecologic exams (5)

Answer 1

1) Pelvic and vulvar exam
2) Speculum/colposcopy exam of vagina and cervix. Uses a speculum and a microscope/magnifying type device to look at the walls of the vagina and cervix
3) Extended colposcopy with acetic acid to visualize areas of increased nuclear density. - white areas may be precancerous or cancerous lesions.
4) Pap smear
5) Bimanual pelvic exam. Two fingers in the vagina and one hand pressing down on the abdomen to feel the uterine fundus. Begin palpating at the umbilicus and move down.

Question 2

What are the obstetric exams.

Answer 2

1) Pre-conception exams/consults. Women should ideally see an obstetricist prior to conceiving.
2) Prenatal exams. First exam between 6-8 weeks gestation, then follow ups every 4 weeks until week 28, then every 2 weeks until week 28-35, then every week until delivery.

Question 3

What is Naegele’s rule for calculating due date

Answer 3

From the last menses, Add one year, subtract 3 months, then add one week.
This is about 40 weeks from the start of the last menstrual period.

Question 4

What are the dates of the trimesters of pregnancy

Answer 4

First: 1-12 weeks

Second: 13-24

Third: 25-40

Question 5

Describe aims of first obstetric visit

Answer 5

Full medical history

• All surgeries allergies
• Any risk factors for pregnancy complications
• Menstrual history, date of last period, what are their periods usually like and how regular, any metrorhagia.
• Obstetric history, previous pregnancies any complications.

Full physical exam
Pelvic exam
Breast exam

Full blood count

b-HCG measurement

Urinalysis, urine culture, and fasting glucose

Dental exam - poor hygeine associated with preterm labor and preeclampsia

Patient education - avoiding alcohol and tabacco, discussing recommended diet and supplements.