Week 1 Flashcards
obstetric examination parts
1-Inspection from end of bed
–Expose maternal abdomen from symphysis publis to xiphoid
2-Vital Signs (temp, BP, pulse)
3-Cardiovascular
4-Respiratory
5-Neurological (If relevant to history)
6- Abdominal
—Palpation for lie and presentation, SFH measurement
7-Pelvic ( Sterile speculum vs digital vaginal)
Inspect the maternal abdomen for
Striae gravidarum (Stretch marks)
Linea nigra (midline hyperpigmentation)
Scars (i.e. appendicectomy, previous Caesarean Section…)
Tatoos, Piercings etc
Abdominal swelling or distended abdomen consistent with pregnancy
How to take BP in pregnant women
Blood pressure should be taken from the right arm with the patient lying in a semi recumbent position at an approximately 30 degree angle. Use large cuff for obese patients to ensure correct measurement.
the importance of urinalysis in pregnant women?
Proteinuria- diagnosis of Pre-eclampsia, renal disease
Haematuria- underlying renal disease, renal colic, UTI
Glycosuria – underlying diabetes, prompt GTT
Leucocytosis, Nitrates – diagnosis of UTI
NEUROLOGICAL examination ?
- Examine reflexes and clonus in patients with Pre-eclampsia
- Fundi
position of abdominal palpation
Examined in the recumbent position, left lateral (to avoid compression of IVC)
what do we look in abdominal examination
1- SFHM
2- Lie and Presentation of the fetus
how to measure SFH
Symphyseal fundal height (SFH)
Using a tape-measure from the upper border of the Symphysis pubis to the fundus
Record measurements in cm
SFH in cm = weeks of gestation +/- 2cm
HOW do you locate the fundus
- -Palpate down from the level of the Xiphoid with the ulnar border of your left hand until you reach the fundus of the uterus
- -At umbilicus at 20 weeks
what is the lie? and are the different lies? who the lie examined
The ‘lie’ is the position of the fetus with respect to the longitudinal axis of the uterus
The lie must be either
longitudinal
Transverse/ Oblique.
Lateral palpation determines the lie of the fetus
what subjective assessment the abdominal palpation allows us to measure
The abdominal palpation allows a subjective assessment of fetal size and amniotic fluid volume
what is the lateral palpation
Place both hands flat on either side of the maternal abdomen
The fetus is then gently ballotted between the hands to determine the fetal lie and presentation
what is the 2 parts of presentation
1- which part is presented
- with the longitduenal lie, either cephalic or breech
2- proportion of fetal head passing the pelvic brim(inlet)
The proportion of the fetal head palpable within the abdomen compared with the proportion that has descended into the pelvis is described in fifths.
5/5: head is completely free and mobile within abdomen
4/5: head is beginning to enter the pelvic brim
3/5: most of head is within the pelvic brim
2/5: the widest diameter of the head has passed through
the pelvic brim
1/5: minimal portion of head palpable abdominally
head engagement?
The head is engaged when the widest part (biparietal diameter) has passed through the pelvic inlet.
what is the normal fetal heart rate, and how can we measured it
Fetal Heart (110- 160 bpm)
A Pinnard or Doppler can be used to detect the fetal heart
It is best heard over anterior shoulder of the fetus
lower limb examination
Oedema
Bilateral Pitting Oedema: very common in third trimester
Varicose veins
Evidence of deep vein thrombosis Erythema Pain Swelling Heat
indications for sterile speculum examinations
To confirm spontaneous rupture of membranes (in this case, amniotic fluid may be seen forming a pool in the posterior vaginal fornix)
To assess vaginal bleeding in pregnancy
To assess cervical dilatation in preterm labour
digital vaginal examination is indicated
confirm the diagnosis of labour
to assess cervical favourability for induction of labour
to assess the progress in labour
Bishop score
Position of the cervix (posterior/ mid-position/ anterior)
Consistency (firm/ medium/ soft)
Cervical Length or effacement (in cm or %)
Dilatation of the cervix in cm
Station of the fetal head in relation to the ischial spines
A transverse lie carries a risk of ?
A transverse lie carries a risk of cord prolapse in the event that the membranes rupture.
effacement meaning
With regard to the cervix: it shortens in preparation for labour, this is referred to as ‘effacement’
incision used in Caesarean section
Pfannenstiel incision leaves transverse scar
is the murmur normal in pregnancy
physiological murmur is normal
for who PRECONCEPTION CARE is offered
General considerations:GP
Medical disorders: GP/HOSPITAL Physician and obstetric: Medications should be reviewed
An obstetric complication in a prior pregnancy, or a gynaecology condition
- Her Gynaecologist
- congenital malformation –> specialist in fetal medicine or a geneticiss
GENERAL PRECONCEPTION COUNSELLING where it took place what history is taken what examinations are performed what standard and targeted tests are done
Usually takes place at the GP surgery
Review family history, gynaecological history, medical history
Clinical examination to exclude cardiovascular, respiratory, renal, neurological disease
Standard:Cervical Smear if due, Rubella Immunity, Varicella Zoster Immunity
Targeted: e.g.Thyroid panel if history of thyroid dysfunction or if clinical indication, Hepatitis screen if at risk (may require immunization)