antenatal exam Flashcards
How would you welcome Marsha to her appointment
Start by introduce myself
Confirm her ID by asking name and compare to her notes to insure correct person
Going to take an holistic overview- looking for paleness, tiredness and i would ask open ended question if these were obvious
I am going to make sure there is no reason i shouldn’t be doing the exam- vaginal bleeding or abdominal pain and refer if so
I will explain to marsha the components of the exam and gain her consent
Throughout i will be watching for her verbal and non verbal cues about how she’s feeling
What is the purpose of antenatal care
Ensure maternal health and well-being
Ensure fetal health and well-being
I am looking for any deviations from the normal and refer to the correct person if necessary
How would you prepare the room for antenatal exam
Ensure we are in a space to maintain privacy and dignity
Close door, curtain and window, add do not disturb sign
Room is comfortable and warm
How would you prepare yourself and what equipment would you require
sphygmomanometer (Sphyg)-Blood pressure
stethoscope
urinalysis sticks to dip urine
doptone, doptone gel
pinard
Case notes
single use tape measure
I would follow the who guidance- 5 stages of hand hygiene and 7 steps of hand washing
If hands are visibly clean can use hand gel
Have PPE ready
Describe the component parts of antenatal exam
holistic overview- open ended questions about pregnancy
Do BP with sphyg- when sitting calm and not talking- compare to booking appointment- looking for signs of preeclampsia, hypertension, any other concerns
Urine specimen- within the last hour- testing for protein ( urine infection), sugary (sign of gestation diabetes
Looking for signs of adema- additional fluids in the tissue, looking for lower limb, in figures , face- ask questions about pain or if Marsha feels it’s worsening
Explain reason for performing an abdominal examination at this stage of pregnancy
asses fetal size and growth
asses fetal health
diagnose location of fetal parts
detect deviations from normal
explain how to prepare Marsha and what position she should adopt
ask marsha to go to toilet- so bladder is empty as can impact on measurement and more uncomfortable
lower bed or get stool to help her onto bed
lie in a semi recumbent position, pillow or wedge under your hip ( to keep in a left lateral tilt) to take weight of your gravid uterus or your large vessels
what will be the effect if inferior vena-caval occlusion
ventacevel occlusion- this is when your uterus compresses the vena cava and stops the Venus return- if got this you can suffer from supine hypertension ( feel lightheaded, vomit, dizzy, loose consciousness)
If feeling these, i would asses you onto left lateral, takes weight off gravid uterus off large vessels, to allow venus return and will start to feel better
what would midwife do if Marsha became dizzy
Stay in room, call fore help and give Marsha time to recover
explain how you would preform an abdominal examination and explain in detail what you would do and why
Ask Marsha to lower cover to a place she feels comfortable that exposes her abdomen- informed consent, privacy and dignity
Inspect abdominal- shape and size ( 1st baby egg shaped, more than one baby more round due to tone of uterine muscles)
If baby is in a longitude no lie position- egg shaped
transverse lie- more broad
Looked to see for fetal movement
Look for distended bladder- a rise above symphysis pubis
Looked to see if dip at umbilicus pubis- indication baby is lying in an occipital posterior position
Look for rashes or signs of itchy, give advice
Any previous scars - c-section above symphysis pubis, or any other previous surgeries
Look for stretch marks- old stretch marks (silvery)
New stretch marks (red)
Linear nigra - line of pigmentation ( comes from symphysis pubis- umbilicus
Look for any bruising or concerns- domestic violence ( ask in confidential manner)
Fundal Height Measurements
Estimate gestation of fetus- measure in cm and should match the number of weeks gestation (36 weeks)
Measure from top of uterus down to symphysis pubis- measure up to down because fungus moves as uterus grows
Single use tape measure- infection control
Number face down so there is no bias judgement
go from
Using side of hand - find curved area of upper border of uterus- firm area
Tape measure at zero- mid line down stomach
Do measurement once- 36cm
Document in growth chart
Things that can effect the size may be- lax abdominal muscles (May be from previous pregnancies, maternal obesity, multiple pregnancy, polyhydramnios, oligohydramnios, large/ small for gestation dates fetus, fetal lie, size and growth
Fundal Palpation and reason for it
Try to identify what is located in the upper poll of the uterus- helps indicate what the presentation of the baby is
Use two hands starting at the side of the fundus, figures close together working round till can feel upper poll. Can feel something broad and can move between two hands- buttocks. If it was head it would be round hard and ballotable (move easily between fingers)
Lateral palpation- reason for doing it
Anchor uterus with one hand around the height of umbilicus
With other hand I’m going to walk my hand down the side- determine if there is anything firm and solid, resistant to figures
Switch hands doing exact same - softness, irregularity, feel feet at top, hands a bottom
Fetal spine- towards maternal right
Fetal limbs - towards maternal left
Pelvic Palpation - reason for doing
Do to so i will need to turn away- let me know if you are uncomfortable or want me to stop
NICE do not suggest routine pelvic palpation until 36 weeks - as that’s when its important to know the presentation of the fetus
This will let us know presentation and engagement
Two hands above symphysis pubis, ask Marsha to bend knees and take a deep breath
As she takes a breath I’m going got push inwards and downwards- to see how much fetal head can be felt- cephalic, not ballotable, 3/5 palpable
All normal
when would head become engaged
Expect the head to be engaged at around 36 weeks if a prim and if paras might not be until the onset of labour the head becomes engaged
