diagnostic methods in obstetrics Flashcards
anamnesis
⮚ Important aspects of the menstrual history must be obtained.
⮚ The woman should describe her ,
1. usual menstrual pattern,
2. including date of onset of last menses,
3. duration,
4. flow, and
5. frequency.
⮚ Items that may confuse the diagnosis of early pregnancy are
1. atypical last menstrual period,
2.contraceptive use, and
3.a history of irregular menses.
physical examination
- PR, BP, palm ( palmar erythema associated w preg ), hands ( nails for anemia ), measure BP in semi-recumbent position
- tongue n oral cavity, hypertrophy of gums n thyroid gl
- breast
heart - lungs auscultation ( pulmonary edema )
- fundal height ( SFH in cm )
- No. of poles ( twins or singleton )
- Doppler device for baby’s heart
- check for edema ( pre-tibial pressure 15s )
- dip urine for protein
- abd inspection : distension of abd, fetal mvm, scars, marks / striae
- VE rarely
- in HT, check optic disc by fundoscopy, lung bases for pulmonary edema
- check reflexes in upper n lower extremities n ankle clonus
pelvic examination
- a variety of pelvic shape may explains difficulties in labour
- gynaecoid pelvis is most favourable for labour and most common
- android, anthropoid, and platypelloid pelvis are other forms
- exam needed to checked whether previous fracture occur or not, maybe dt labour
- pelvis divide into true and false pelvis, which are separated by pelvic brim or inlet
- normal transverse diameter of pelvic brim is 13.5 cm; wider than AP diameter, 11cm
- thru vaginal exam, diagonal conjugate can be measured, norm 12.5cm
- interspinous distance, intertrochanteric distance can be measured using pelvimetry whereas true conjugate can be calculated by few methods
ultrasound examination
- uses sound waves delivered at high frequency
- the higher the frequency, the higher the resolution ??? the less the tissue penetration
- plays a vital role in the assessment of maturity, growth, well-being n abN
- routine uses :
● Confirmation of on going intrauterine preg
● Assessment of gestational age ( CRL, biparietal, femur length )
● Identification of multiple preg
● Recognition of major anomalies - specific uses :
● Threatened abortion
● Antepartum hemorrh
● Fetal growth studies
● Assessment of high risks
● Postpartum retained products
Pelvic masses
- doesn’t produce harmful effects on fetus or mother
- it can cause bioeffects on cells by inducing heating
dopplermetry
Dopplermetry
- shows direction n characteristics of blood flow n can be used to examine the uteroplacental or fetoplacental circulations
- indicated in IUGR, suspected fetal hypoxemia, cord malformations, unexplained oligohydramnions, fetal cardiac anomalies
- Doppler of uterine art → umb vessels → fetal ??? → fetal cerebral vessels
fetal cardiotocography
- tests fetal well being n gives info abt baby’s condition
- FHR is recorded continuously by an US transducer on the mother’s abdomen for a period of 20-30min
- a tocograph is also applied to record any uterine contractions n the mother is asked to note fetal mvm
- may be done once or twice a wk
- a fetal sleep pattern may be observed in wh there is absence of mvm n accelerations
Colposcopy
It is the examination of the vagina and cervix using and endoscope. We may see:
- Cervical dysplasia in women with abnormal pap smears. Biopsy can be done.
- See a green filter 🡪 visualization of blood vessels and vascular pattern.
- Lugol solutions stains only segment of epithelial cells having normal glycogen content. - Therefore, abnormal cells are seen.
- Excision procedures and cryotherapy may be done endoscopically.
amnioscopy
- most accurate test of fetal maturity
- AF is evaluated for creatinine [ ], L/S ( lecithin sphyngomyelin ) ratio, phosphatidyl glycerol content
- an L/S = 2 : 1 indicates maturity
- the presence of phosphatidyl is an indication of lung maturity
- AF may be contaminated by blood, meconium or other fluids eg urine or vaginal contents
- has honey comb appearance in hydatid mole disease
placentacentesis
It is the puncture of the placenta and obtaining a sample of cells that can be cultured/grown.
cordocentesis
- performed transcervically or transabdominally at 9 – 11wks
- under US, a sterile catheter is placed into uterine cavity n directed towards placental site
- chorionic villi r aspirated n analysed
- percutaneous UC sampling : insert sterile needle within umb vessels to obtain fetal blood
- done in 2nd n 3rd trimester n blood is analysed for c’somal n metabolic abN
