Practical procedures Flashcards
examining pregnant abdomen steps
- general inspection
- inspect abdomen
- palpate abdomen
- fundal location
- fetal lie
- fetal presentation
- fetal engagement - SFH
- fetal heartbeat
general inspection features
pain scars pallor jaundice oedema
inspect abdomen for what
- shape
- movements (visible >24 weeks)
- surgical scars
- linea nigra
- striae gravidarum
- striae albicans (mature stretch marks)
different fundal locations by gestation
12 weeks = pubic symphysis
20 weeks = umbilicus
36 weeks = xiphoid process of sternum
how do you assess fetal lie?
palpate each side of uterus
hard side = back
other side = limb
3 main types of fetal lie
- longitudinal lie
- oblique lie
- transverse lie
when is a fetus considered engaged?
> 50% presenting part in pelvis
entire head in abdomen = 5/5th palpable = not engaged
can’t feel head = 0/5th palpable
SFH
fundus to symphysis pubis with tape measure
fetal heart beat
over anterior shoulder
palpate maternal pulse
LMP wheel
put arrow on date that was first date of your last menstrual period
Naegele’s Rule
first day of LMP + 9 months + 7 days
if cycle longer than 28 days, add the extra number of days on
How to use Epipen?
blue to sky, orange to thigh
- lie flat on ground in comfortable position
- pull off blue release
- hold orange tip 10cm away from outer thigh (hold thigh still)
- Jab epipen firmly to outer thigh at right angle, hold firmly for 3 seconds before removing
- call 999
website to tell people about for Epipen use
epipen.co.uk
information for patients
AMTS
- current year
- age in years
- time to nearest hour
42 West Street - where are you now?
- name 2 people here
- DoB
- WW2 end
- Monarch
- 20-1
- recall address
growth charts used
UK WHO growth charts
key points about growth charts
- expect head growth centile to be bigger than body
- birth/weight/head circumference at age 0
- if point is within 1/4 of a space of line = on centile
- if not describe as between centil
when to investigate?
sustained drop through 2 or more weight centiles
what does 91st centile mean?
91% children below
how many children are close to mid parental height?
90% children within +/- 2 centiles of mid parental height
how to calculate mid parental height?
- plot mum and dad height
2. join two lines, where cross = MPH centile
Tanner stage meaning
1 = pre-puberty 2/3 = in puberty 4/5 = completing puberty
partogram components and timing
30 mins: maternal HR
1 hour: contractions (frequency, strength, regularuity), liquor
4 hour: BP, temp, urinalysis of mum, cervical dilation and head descent from PV exam
how to explain bimanual to patient
vaginal exam
involve me using one hand to feel your tummy and the other to place 2 fingers into the vagina
it allows me to assess the vagina and reproductive organs
shouldn’t be painful but will feel a little uncomfortable
you can ask me to stop at any point
you will need to keep your knees bent but legs apart
things to do before starting
- check understanding, get consent
- request chaperone
- any pain?
- let patient pass urine
- remove underwear and cover with sheet
external parts of exam
abdo exam: palpate for massess/tenderness, palpate groin for lymphadenopathy
external exam: inspect, ask pt to cough, palpate labia majora
steps to bimanual
lubrication and 2 fingers
- feel for smoothness, mobility, firmess
- flick up and assess uterus size
- anteverted/ retroverted
- adnexal massess
- move cervix side to side for tenderness
- remove fingers and inspect for blood/discharge
explaining speculum to patient
involve me inserting a small plastic device into vagina
allow me to visualise the neck of the womb
shouldn’t be painful but will feel a little uncomfortable
can ask me to stop at any point
you may experience some light vaginal bleeding after procedure
steps to speculum
- lubricate speculum, warn patient
- part labia with left hand
- gently insert with right hand and rotate 90 degrees
- slowly open and inspect cervix
- tighten screw
what to look for through speculum?
abnormal discharge erosions ulcerations growth inflammation bleeding polyps
explaining smear to patient
speculum +
I will then place a small brush into vagina and sample cells from neck of the womb
shouldn’t be painful but a little uncomfortable
steps to carrying out a smear
- insert brush into endocervical canal
- rotate brush 7 times, 360 degrees in clockwise direction
- carefully remove brush
- place tip into liquid-based cytology container
Abortion act A
greater risk to pregnant woman
Act B
to prevent grave permanent injury to health of pregnant women
Act C
< 24 weeks, continuing involve risk to health of woman
Act D
< 24 weeks and continuing have effect on existing children
Act E
child born with physical/mental problems
F/G
emergency
save and prevent grave permanent injury to pregnant woman
