Clinical methods in obstetrics Flashcards
Past obstetric history is one of the most
important areas for establishing the risk in the current pregnancy. What is it important to include in the obstetric history?
Miscarriages. Stillbirth. Preterm delivery. Preeclampsia. Placenta abruption. Congenital abnormalities. Macrosomic baby / gestational diabetes. Fetal growth restriction (FGR).
What is gravida?
Number of previous pregnancies regardless of how they ended.
What is parity?
Number of live births at any gestation or stillbirths after gestational week 24.
How is a pregnancy dated? What is the reason for dating a pregnancy?
By used the date of the first day of the last menstrual period and counting 40 weeks forward. Dating a pregnancy gives an estimate of the date of delivery.
What is defined as term delivery?
Delivery from week 37-40.
What is the cut off for abnormally high blood pressure during pregnancy?
BP > 140/90 is not normal, and should be further investigated.
What can be included in the clinical obstetric examination?
The indicated examination depend on how far along the pregnancy has come. Some important examinations/tests are:
Blood pressure.
Urine dipstick (for proteinuria, asymptomatic bacteruria, and glucosuria.)
Inspection of the abdomen.
Palpation of the abdomen (Leopold’s maneuvers).
Measurement of symphysis-fundal height (SFH).
Auscultation of the fetal heart sounds using a Doppler device or a Pinnard’s stethoscope.
What is it important to keep in mind if a urine dipstick test during an obstetric examination is positive for proteinuria? What about glucoseuria?
Proteinuria could be a sign of preeclampsia.
Glucoseuria could be a sign of gestational diabetes.
What are the main thing to look for during inspection of the abdomen while performing an obstetric examination?
Shape of the abdomen.
Fetal movements.
Scars.
Describe Leopold’s maneuvers.
First maneuver. How high is the fundus uteri? Fundal grip. Both hands at the upper abdomen.
Second maneuver. Which way is the back and extremities? Facing the woman. One hand is standing still while the other is used to palpate. Repeat using opposite side and hands.
Third maneuver. What is the presenting part? Is the presenting part engaged or not to the pelvic entrance? Hands on the lower part of the abdomen, just above the symphysis.
Fourth maneuver. Determining the presenting part if it is deep in the pelvis entrance. Facing the woman’s feet. Locating the fetus’ brow.
How is the symphysis-fundal height (SFH) measured?
The patient is lying in a supine position with an emptied bladder.
Hold the 0 cm marking of the tape with one hand, securing it over the upper border of the symphysis pubis bone. With the palm of the other hand on the abdomen, pass the tape in a straight line form the symphysis pubis over the uterus to the fundus uteri until you feel a resistance in the abdominal wall. Use the cubital edge of the hand to sustain the tape in place at the point of the fundus uteri.
What is Bishop’s score? What are the components of Bishop’s score?
Bishop’s score, also known as cervix score, is a pre-labor scoring system to assist in predicting whether induction of labor will be required. It has also been used to assess the likelihood of spontaneous preterm delivery.
The components of the score are dilation of the cervical os (in cm.), length of the cervix (shortening in percentage), consistency of the cervix, position of the cervix, and station of the fetal head is relation to the ischial spines of the maternal pelvis.
What is considered a favorable score when using Bishop’s?
A score above 5 is considered favorable.
What are the two most common fetal head position in cephalic presentation?
Occiput anterior and occiput posterior presentation.
What are the possible fetal head positions in cephalic presentation?
Right occiput posterior, left occiput posterior, right occiput transverse, left occiput transverse, right occiput anterior and left occiput anterior.
