History and examination

Question 1

How do you calculate the expected date of delivery? (EDD)

Answer 1

Last menstrual period - 3 months + a year and 7 days.

Question 2

When does the EDD need to be adjusted?

Answer 2

For menstrual cycles which are not 28 days. If they are longer, the number of days different to 28 days needs to be added on. For shorter, the number of days different need to be removed.

Question 3

What are the methods to calculate gestational age?

Answer 3

LMP method/IVF implantation
Ultrasound measurement of the crown-rump length between 6 and 13 weeks and compare to average sizes.
Head circumference between 14 and 20 weeks if no early scan and LMP is unknown.

Question 4

How do you denote parity?

Answer 4

Nulliparous = none
Multiparous = has delivered live/potentially live (>24 week) babies.
Para 3 = 3 term pregnancies.
If a lady has miscarried/aborted then is is para 3+2.

Question 5

What is gravidity?

Answer 5

Describes the number of times a woman has been pregnant, including terminations, miscarriages and term births.

Question 6

What are the steps of a palpation obs examination?

Answer 6

1. Find the fundus and measure from here to the symphysis pubis with a tape measure facing down.
2. Palpate down the foetus towards the pelvis using dipping movements to palpate foetal parts and estimate liquor volume. Find the lie.
3. Assess presentation by pressing the fingers of both hands down firmly just above the symphysis pubis (what is occupying the pelvis) and also calculate the engagement of the head (>2/5 palpable is not engaged).

Question 7

How do you perform auscultation on a foetus?

Answer 7

You listen over the anterior shoulder (usually palpable between the head and the umbilicus). HR should be between 110-160bpm.

Question 8

When is the fundus palpable?

Answer 8

12-14 weeks

Question 9

What age does the uterus reach the umbilicus?

Answer 9

20 weeks

Question 10

What age does the uterus reach the xiphisternum?

Answer 10

36 weeks

Question 11

What are the common causes of polyhydramnios and how can you tell if a mother has this?

Answer 11

Causes: diabetes/gestational diabetes, foetal abnormality, idiopathic.
The uterus will feel tense and your fingers will need to dip in far to feel any of the foetus.

Question 12

How can you tell if a foetus is breech or not?

Answer 12

If it is the head in the pelvis, it is hard and if free, can be gently bounced or balloted between 2 hands, whereas a breach is softer and less easy to define (feet and bum).