Antenatal Examination Flashcards
- How would you welcome to appointment? Max 6
- Introduce self and role
- Confirm patients name and dob
- Observe overview - tired/pale/happy
- Ask how she is? Verbal and non verbal answers
- Talk about exam and look out for any contraindications (vaginal bleeding/abdominal pain)
- Ask consent
- What is the purpose of antenatal care? Max 3
- Maternal health and well-being
- Fetal health and well-being
- Deviations -pass on
- How would you prepare room for examination? Max 1.5
Close doors/curtains-privacy
Warm room
- How would you prepare self and what equipment would you need? Max 4
- Wash hands-WHO 5 stages of hand hygiene and 7 steps of hand washing- sanitiser if visibly clean
- PPE- gloves and apron
- Gather equipment
- Urine sticks
Pinnard
Doptone and gel
Tape measure
B/p machine and cuff or sphygmomanometer
Stethoscope
Notes
Watch
- What are the main components of antenatal examination? Max 5
- Holistic overview
- Blood pressure- gestation vs booking - hypertension or pre-eclampsia
- Urinalysis (urine last hour) - protein - pre-eclampsia
UTI
Infection
Sugars -GDM
Blood or ketones - Look for oedema or swelling - feet/face/ankles/fingers/
- Abdominal examination
- Explain reasons for performing abdominal examination at this stage in pregnancy? Max 4
- Check baby growth/size/health
- Check location of FH for auscultation
- Check fetal position
- Check for engagement
- Deviations from normal
- Preparation and positioning of patient is important. How would you prepare patient and what position should she be in? Give reasons. Max 5
- Ask if need toilet- comfort and fundal height
- Put bed down if it can - stool or hand up
- Lie in semi-recumbent position - left tilt with pillow or wedge for vena caval occlusion stops venal return
- Arms down by side relaxed- fundal height and position
- What would be the effect of vena cava occlusion? Max 3.5
Stop Venus return
Supine hypotension
1. Dizzy
2. Nausea
3. Fainting
- What would the midwife do if patient became dizzy and why? Max 2
- Roll onto side- left lateral off back
- Venus return to big vessels
- Get help but stay with her
10a) How would you perform abdominal examination and why?
Inspection? Max 9
CONSENT AND PRIVACY AND DIGNITY
1. Reveal abdomen
2. Inspect shape - Ovoid shape (more round Parous)
3. Size-gestation
4. Fetal movements
Look out for scars - from previous surgeries
Rashes - self care advice
Scratches
Striae gravidarum -stretch marks
Liner Nigra- line of pigmentation
Bruising- evidence on GBV- ask in confidential if seen- sensitive manner
10b) fundal height measurement
What factors may affect size of uterus? Max 10
- Parity
- Gestation
- Number of fetuses
- Full bladder
- Size of baby
- Poly/only hydramnios
- Position of baby
- BMI-maternal obesity
- Fybroids
Fundal height- size (cm) vs same in gestation +/- 2cm
Upper uterus- side of hand from xiphisternum- upper curve
Use tape face down to symphysis pubis (36cm)
Plot on growth chart
10c) fundal palpating
What is reasons for doing fundal palpation? Max 5
Identify presentation- whole picture
Only fundal area
Side to side
Find buttocks? Cephalic
Work with fingertips close together-side of fundus till feel something
10d) lateral palpation
What is reason for doing? Max 5
Determine lie of baby
Anchor one side then swap - level of umbilicous
Press with fingertips together
10e) pelvic palpation
Reasons? Max 6
To determine engagement
Confirm presentation
Turn away
Not done until 36 weeks
Above symphysis pubis - bend knees up to make more comfy
Deep breath in
In and down- round/hard/not balotable
3/5 palpable and cephalic presentation
- When would you expect head to be engaged? Max 2
For prim 36-38 wks
Parous - onset of labour
