Antenatal Examination

Question 1

Objectives of antenatal care

Answer 1

• To detect correctable abnormalities of the mother and foetus
• To institute timely and appropriate treatment
• To offer emotional support

Question 2

What tests should we perform for a woman during routine antenatal check-up?

Answer 2

1. BP (5th Korotkoff sound for DBP) = 140/90 mmHg is the cut-off for high blood pressure
2. Pulse
3. Body weight, height
4. Urine dipstick for protein and sugar (dipstick should be read after one minute)

Question 3

What must we bear in mind if urine dipstick comes back +very (proteinuria)?

Answer 3

• The result might be spurious (pregnant women are hyperestrogenic = increased amount of vaginal discharge)
• Test midstream specimen instead!!!

Question 4

What tools are needed during antenatal examination?

Answer 4

• Stethoscope for CVD examination
• Measuring tape for abdominal exam (symphysio-fundal height)
• Foetal Doppler Machine for foetal HR

Question 5

How do we perform an abdominal examination?

Answer 5

Expose from xiphisternum to pubic symphysis (cover pubic area with sheet for comfort)

General
1. Hand hygiene
2. Palpate for ankle oedema

Obstetric abdominal examination

• Inspection
  1. Abdominal distension
  2. Linea nigra
  3. Striae gravidarum (stretch marks)
  4. Foetal movements
  5. Surgical scars (suprapubic transverse scar, laparoscopic scars [esp. over umbiliucs])
• Palpation
  1. Uterine size, symphsio-fundal height (use either border of hand to palpate for fundus)
  2. No. of foetal poles
  3. Foetal lie
  4. Foetal presentation
  5. Foetal engagement
  6. Liquor volume

Auscultation of foetal heart pulsation (Dop Tone machine, best point of auscultation is anterior shoulder, near cephalic end of back)

Question 6

How is symphsio-fundal height measured? What may give a shorter SF height than expected in 3rd trimester?

Answer 6

Place 0 mark of measuring tape on upper border of pubic symphysis

[Turn the measuring tape upside down to prevent bias]

From mid-second trimester, one centimetre corresponds to one week of gestation

Foetal head engagement in 3rd trimester may give shorter SF height than expected

Question 7

What may affect correlation of SF height with foetal size?

Answer 7

• Thick maternal abdomen
• Presence of uterine fibroid

Question 8

What are the landmarks for uterine size?

Answer 8

12 weeks: Fundus is just palpable above pubic symphysis
20 weeks: Level of umbilicus
36 weeks: Xiphisternum

Before gradually coming down again as foetal head engages into pelvis

Question 9

How do we palpate for foetal parts?

Answer 9

• Use both hands to palpate foetal parts (should be able to detect presence of more than one foetus)
• Determine where the foetal poles are

Question 10

What is foetal lie?

Answer 10

• Relationship between long axis of foetus and mother
• Longitudinal / Transverse / Oblique

By knowing the ‘lie’, we can determine where the foetal back is = helps to locate where to auscultate foetal heart later

Question 11

What is foetal presentation?

Answer 11

• The part of the foetus that is overlying the maternal pelvic inlet
• Cephalic (foetal head in lower abdomen)
• Breech (foetal head near fundus)
• More

Question 12

What is fetal engagement?

Answer 12

• Largest diameter of presenting part has entered pelvic brim
• For cephalic presentation, the largest diameter is generally:
  — The biparietal diameter, or
  — The suboccipitobregmatic diameter

Question 13

What unit is used to measure the extent of the foetal head above the pelvic brim?

Answer 13

Question 14

When is the head ‘engaged’?

Answer 14

When only 2/5 of the foetal head is palpable abdominally