Examination Flashcards
Inspection and Preparation:
Position:
15 degrees on bed
- What do you recommend patient does before examination?
General inspection:
Appearance - what to look for?
Peripheral - Top to toe:
- Head and neck - What to look for?
- Legs and feet - Swelling, oedema, varicose veins - why?
Generally well?
Anxious
Tired
Pale
Jaundiced sclera (Obstetric cholestasis)
Conjunctival pallor (Anaemia)
Facial oedema (PE)
Palpate radial pulse!
Abdominal Inspection:
Inspection:
Fetal movements - What gestation is this expected?
Lines - what are the following:
- Striae gradvidarum - colour?
- Striae albicans - colour?
- Linea nigra - colour?
What could scars indicate?
What could a Pfannenstiel scar indicate? - 3
What does a wide transverse abdomen suggest? - 3
24 wks
SG - Stretch marks from CURRENT preg - red
SN - Stretch marks from PREVIOUS preg - white/silvery striae
LN - Dark line running from the pubic symphysis upwards
Laparotomy
Laparoscopy
C-section
Ectopic
Hysterectomy
Transverse lie
Twins
Polyhydramnios
Palpation:
(1) Fundal Height:
How do you measure?
Guide for measurement?
Causes of bigger than expected FH?
——- smaller —–?
Tape upside down
Starting at top and measuring to pubic symphysis
Repeat 2-3 times
Inaccurate menstrual history
Multiple gestation
Fibroids
Adrenexal mass
Maternal size
The distance should be similar to the gestational age (1cm per week) in weeks (+/- 2 cm).
Bigger: Macrosomia, polyhydramnios, multiples, wrong dates, fibroids
Smaller: Interuterine growth restriction, oligohydramnios, small baby (Constitutionally small)
Lie:
How to assess?
3 descriptions?
Feel upper abdo from below, where you usually find the soft bum
The back compared to the knobbly limb on the other
Longitudinal (Vertical)
Oblique (Diagonal)
Transverse (Horizontal)
Palpation findings:
Presentation for a longitudinal lie:
- What suggests the head is the presenting part (cephalic)?
- What suggests another part is presenting (breech)?
- What can be done to the head to confirm it’s actually the head?
(3) Engagement - what does 1/5 mean compared to 5/5?
(4) Liquor volume - What does difficulty feeling foetal parts on deep palpation suggest?
What does a tender kidney and/or liver suggest?
Summarise findings as:
(1) Lie
(2) Presentation (Cephalic/breeched)
(3) Engagement
(4) Volume
(2) Firm and round = cephalic
Soft and/or non-round = breech. Foetal head can be often be palpated in the upper uterus.
Balloting - head by pushing it gently from one side to the other.
(3) 1/5 - fully engaged (1/5 of head palpable in the abdomen) - 5/5 - not engaged at all
(4) Polyhydramnios
Longitudinal lie
Cephalic presentation
x/5 of the head palpable in the abdomen
With the back on the left/centre/righ
Auscultation:
What is usually used to do it? - 2
How long should it typically be done for?
Where should you aim?
Over what gestation should the heartbeat be looked for?
Why do you feel the mums pulse at the same time?
The typical range you expect >24 wks?
How may you present this back?
Doppler US/Pinard stethoscope (>24 wks)
1 minute
Locate the back of the fetus to listen for the fetal heart, aim to put your instrument between the fetal scapulae to aim toward the heart.
> 16 weeks (trying before this gestation often leads to anxiety if the heart cannot be auscultated).
To make sure it isn’t hers you’re listening to
Fetal heart was heard and regular
Extras:
When is a vaginal exam indicated?
Extras if PE suspected? - 4
Early pregnancy problems
Later pregnancy to assess cervix - dilatation, length, consistency, and position
Signs of hypertensive crisis:
BP
Hyperreflexia (knee, ankle, clonus)
Fundoscopy - papilloedema, retinopathy
Urinalysis –> Proteinuria
Fetal movements:
When do mothers first notice fetal movements?
A midwife should be called if foetal movements are reduced. What should be done if >28 wks?
18-20 wks - All from 24 wks!!!
CTG asap - Cardiotocography
