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General examination
The general examination should include observation, systemic examination, and laboratory tests.
Inspection
State of health, gait, nutritional status: good/average/poor, build obese/average/thin, personal hygiene,
ability to walk.
Weight
Record the weight in kg or Ibs and should be taken on each subsequent visit. An average patient will gain
8-12kg during the course of pregnancy. Women who start pregnancy with a low weight tend to gain less
weight. Inadequate weight gain is often associated with low birth babies, IUGR, preterm delivery and
poor perianal outcome.
Height
Record the height in cm. A short stature is often associated with a small pelvis. Woman with a height of
less than 4.8'' or 150 cm is more prone to problems of mechanical dystocia and abnormal presentation.
Vital sign
Take temperature, blood pressure, pulse, respiration and record it, if any abnormalities; immediately
inform to senior or doctor.
Head
Colour, texture, cleanliness of head and hair, check for extra growth or tumor.
Eye
Check eyelids, sclera, and cornea for any infection and conjunctiva for pallor: examine conjunctiva,
tongue, and nails for pallor which is indicative of anemia.
Oral cavity
Examine the tongue, teeth, gums, and tonsils. Patient with poor oral hygiene, gingivitis, or dental caries
should be referred for dental care. There may be a sign of glossitis and angular stomatitis.
Neck
Examine for neck veins, thyroid gland or lymph nodes for any abnormality. slight physiological
enlargement of the thyroid gland occurs during pregnancy in 50% cases.
Respiratory system
Check for breathing, size, and shape of the chest, any node or tumor on chest movement of chest muscle
during respiration. Percuss the chest wall for resonance sound, auscultate for detection of breathing
sounds.
Cardiovascular system
Auscultate the heart sound for any abnormalities, identify any cases of a cardiac disease.
Abdomen
In early pregnancy, the abdomen is palpated for enlarged liver, spleen or kidney and any abnormalities.
But in later pregnancy, the abdomen is palpated for a gravid uterus.
Breast
Observe for skin changes during pregnancy; gently palpate the breast for any tumor or nodes, secretion
of colostrum, an appearance of striae.
Edema of legs
Examine for pitting edema over the lower 1/3 of the leg, above the medial malleolus. Edema may be
physiological and postural in origin or a manifestation of a medical disorder like cardiac disease, anemia,
pre-eclampsia, etc.
Varicosities
Note the presence of varicose veins and their distribution. Pregnancy tends to aggravate this condition.
B. Abdominal examination
A prenatal abdominal examination should be performed on women from 12 weeks till delivery of the
baby. The examination should be done on each subsequent visit.
A thorough systematic abdominal examination beyond 28 weeks of pregnancy can reasonably diagnose
the lie, presentation, position and the attitude of the fetus.
Objectives
To diagnose the location of fetal art, lie, presentation, position, presenting part etc
Inspection
Palpation
Palpation
Obstetric grip
Fundal grip
Pelvic grip
Pawlik's grip
Auscultation
Inspection
Skin changes: skin condition, shiny and stretched, evidence of scabies, eczema or prominent veins
Palpation
The fundal height of the uterus is measured in cm from the top of the symphysis pubis up to the
midpoint of the uppermost margin to the uterine fundus after centralizing it.
If the fundal height does not correspond to the expected period of amenorrhea, an investigation should
be done.
Palpation- obstetric grip
I. Fundal grip
Steps
Use tip of the fingers close together and put hand on sides of the fundus
Curve around the upper border of a uterus and palpate them up to the fundus by rocking the fetal parts
from side to side and palpating its surface, consistency, and ease with which it can be balloted an
estimate made of fetal part occupying the fundus of the gravid uterus.
The commonest fetal part occupying fundus is the fetal breech. It is less well defined than the cephalic
pole; it is softer, more irregular and has restricted mobility. It can't be moved independently of the fetal
back
In transverse lie, neither of the fetal poles palpated in the fundal areas
Steps
Support uterus with your hand on one side and palpate the opposite side to determine the fetal back
and repeat in the both right and left aside.
The limb side is comparatively empty and there is small knob like irregular parts.
It finds out what is the presenting part in the lower pole of the uterus
Steps
Place the tip of the four fingers of each hand on either side of the patient abdomen, just above the
symphysis pubis.
Ask a woman to take a deep breath and as she exhales, sink your finger down slowly and deeply around
the presenting part to palpate.
Steps
When the finger and thumbs are approximated, the presenting part is grasped distinctly, if not engaged,
it has mobility from side to side is tested. The fetal head, which is the commonest fetal part to occupy
the lower segment can be felt as a hard rounded, globular, ballotable part:
Auscultation
Auscultation is done to assess the heartbeat of a fetus. It is a reliable indicator of the fetal life inside the
uterus.
Auscultation of the fetal heart sound, rate, and rhythm give an indication of fetal well-being. The location
of maximum intensity can also resolve doubt about the presentation of the fetus.
The fetal heart sound is best audible through the back (left scapular region) in vertex and breech
presentation. However, in face presentation, the FHS are heard through the fetal chest. As a rule, the
maximum intent of the FHS is below the umbilicus in cephalic presentation and around the umbilicus in
the breech.
C. Vaginal examination
It has been well established that a gentle, careful vaginal examination undertaken under the aseptic
condition is safe, informative and doesn’t cause discomfort to the patient. It provides an opportunity to
assess the pelvis and guess fetal pelvic relationship. It also provide following information
Feto-pelvic relationship
Perineal floor: evaluate whether the perineum is soft, stretchable and elastic or hard and rigid
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