ASSESSING AND PROMOTING MATERNAL AND FETAL HEALTH

PELVIC EXAMINATION

PELVIC EXAMINATION
A pelvic examination reveals information on the health of both the internal and external reproductive organs. It requires the following instruments: Speculum Spatula, for cervical scraping Gloves Lubricant 2-3 cotton applicators or cytobrushes Glass slide and a liquid collection device

EXTERNAL GENITALIA
It begins with INSPECTION of the external genitalia. Any signs of inflammation, irritation or infection, such as redness, ulcerations or vaginal discharge, should be noted. The Skene glands that empty into the urethra are checked for infection. The woman is also evaluated for possible infection that of the Bartholin glands. The glands are palpated between the vaginal finger and the thumb, if a discharge is produced from any of these glands-a culture must be obtained. Infection could be caused by N. Gonorrhea.

Internal Genitalia
A speculum is introduced into the vagina to view the cervix. The speculum enters most readily if it is entered in a oblique angle, then rotated to a horizontal position when fully inserted. When fully inserted, and rotated to a horizontal position, the blades are opened so the cervix are visible.

Pap Smear
Is taken for early detection of cervical cancer and diagnosis of precancerous and cancerous conditions of the vulva and the vagina. Materials used for Pap Smear: Speculum Spatula, for cervical scraping 2-3 cotton applicators or cytobrushes Glass slide and a liquid collection device

Vaginal inspection
A culture is done for gonorrhea, chlamydia or group B streptococcus may be taken by gently swabbing the cervix using the cotton-tipped applicators. The specimens obtained are then plated onto a medium to allow for their growth.

Examination of Pelvic Organs

A bimanual examination is performed to assess the position , contour, consistency and tenderness of the pelvic organs. The index and middle fingers of one gloved hand are lubricated and inserted into the vagina so that the walls of the vagina can be palpated for abnormalities. The other hand is placed on the womans abdomen and pressed downward toward the hand still in the vagina until the uterus can be felt within them.

Rectovaginal Examination
The index finger is inserted into the vagina and the middle finger into the rectum. This procedure is done to assess the strength and irregularity of the posterior vaginal wall.

LEOPOLDS MANEUVER

LEOPOLDS MANEUVER
- a systematic examination on ABDOMINAL PALPATION of a pregnant mother to determine fetal position, presentation , engagement, attitude and location of the fetus

FACTORS MAKING IT HARD TO FEEL THE FETAL CONTOUR

1. GROSS MATERNAL OBESITY

2. EXCESSIVE AMNIOTIC FLUID ( POLYHYDRAMNIOS )

PURPOSES OF LEOPOLDS MANEUVER

1. To determine the position of the fetus 2. To determine the presentation of the fetus 3. To identify if more than one fetus is in the uterus 4. To enable the nurse to locate the area where FHT( fetal heart tone) is best heard 5. To determine the engagement

PROCEDURES AND RATIONALE

1. Explain the procedure to the client Rationale: to gain cooperation 2. Ask the mother to void prior to palpation R: to ensure the patients comfort and get accurate results 3. Position the patient in a supine or dorsal recumbent R: to relax abdominal muscles to facilitate palpation

4. Drape the patient accordingly R: to ensure privacy 5. Rub the hands to warm the palm R: cold stimulates the uterus to contract 6. For the first 3 maneuvers, the nurse stands facing the patient, on the fourth maneuver, the nurse stands on the patients feet R: to facilitate palpation of the pregnant abdomen / uterus ( upper portion) and the pouparts ligament

FIRST MANEUVER : FUNDAL GRIP

7.Nurse stands at the side of bed facing the patient . Palpate the superior surface of the abdomen (fundus) finger tips R: to determine which part lies on the fundus Cephalic- hard, rounded, movable or ballottable and the transverse groove of neck is felt Breech- soft, no groove , usually more angular and nonballottable

SECOND MANEUVER: UMBILICAL GRIP

8. Palpate the sides of the abdomen by placing the palmar surface of both hands on either side of it R: to determine where fetal back is located in relation to the L or R side of the mothers abdomen , the fetal back is area where FHT is best heard

9. With one hand steady on one side, make a slightly circular motion with fingers of the other hand on the other side starting on the top going towards the lower segment of the uterus R: to enable the examiner to feel the shape and consistency of the part palpated

10. Do the same on the opposite side, that is same procedure as no. 9.
R: BACK - is located, it is felt as a SMOOTH, HARD, and RESISTANT PLANE ELBOWS AND KNEES numerous nodulation

THIRD MANEUVER : PAWLICKS GRIP

11. Grasp the lower abdomen above the symphysis pubis with the hand nearer the mothers legs using thumb and fingers
R: determines the part that is at the pelvic inlet and its mobility : same findings as L.M. no.1

FOURTH MANEUVER : PELVIC GRIP

12. Nurse faces the patients feet R: to facilitate palpation of the pouparts ligament 13. Place the tips of the first three fingers on both sides of the lower uterus about 2 inches above the inguinal region / pouparts ligament R: these are the most sensitive parts of hands therefore the parts are easily felt

14. Press downward and inward in the direction of the birth canal . Note that the finger on one hand meets no obstruction and glide over the nape of the baby's neck . The other hand meets an obstruction an inch over the pouparts ligament. This is the brow of the baby R: to enable the examiner to determine flexion of the head anterior and posterior position of the fetal occiput and engagement of the head

15. Place the patient on a comfortable position 16. Record the findings correctly, interpret and relay findings to the mother

MCDONALDS RULE
- estimation of AOG in months and weeks by fundic height measurement.

Normal Values of Fundic Ht.

5mos or 20 Wks = 20cm 6mos. or 24 wks.= 21-24cm 7mos or 28 wks. = 25-28cm 8mmos or 32 wks.= 28-30cm 9mos or 36 wks.= 30-32cm

 symphysis-fundal height measurement, is a common method of determining, during mid-pregnancy, that a fetus is growing in utero. the measurement is made from the notch of the symphysis pubis to over the top of the uterine fundus as the woman lies supine.

 it becomes inaccurate during the 3rd trimester of pregnancy because the fetus is growing more in weight than in height during this time. if fundal height is much greater than the standard value, it suggests multiple pregnancy, a miscalculated due date, a large for gestational age infant, hydramnios or possibly even H-mole. if the fundal height is much less than, it suggests that either the fetus is failing to thrive, the pregnancy length was miscalculated or an anomaly.

Formula: Fundic Ht. In cm. X 2/7

NUTRITIONAL HEALTH DURING PREGNANCY

 the surest way to have a healthy baby is to live a healthy lifestyle. The nutritional status of the mother prior to pregnancy and during pregnancy can affect the health of the newborn baby. Nutrition can affect the newborns birth weight and risk of infant mortality.

Healthy Weight Gain in Pregnancy

The proper rate of weight gain should be: 2-4 pounds in the first trimester 10-11 pounds in the second trimester 12-13 pounds during third trimester.

Increased Nutrient Needs during Pregnancy

Folic Acid:
- fetal and placental growth and the prevention of neural tube defects. The recommend intake of folic acid for pregnant women is 600ug per day. Recommended intake of: green leafy vegetables dried beans citrus fruits fortified cereals and/or by taking a folic acid supplement.

Calcium: -help build and form the babys bones. -1,000mg of calcium per day, which equals about 3 cups of milk. Vitamin D: -deficiency during pregnancy can cause ... -a failure of proper teeth growth in the infant -decrease fetal bone growth -cause a low birth rate. The main source of vitamin D is the sun. -15 min of sun exposure a day or take a vitamin D supplement.

Iron: Because there is a marked increase in the maternal blood supply during pregnancy, there is an increased demand for iron. 700-800mg iron thought out the pregnancy. Foods that are high in iron include: poultry, fish, beef, nuts, dried beans, spinach, cheese and milk. 10mg iron supplement 3 times a day during the second and third trimester Food to Avoid during Pregnancy Alcohol: No alcohol should be consumed during pregnancy. Alcohol consumption could lead to a condition known as fetal alcohol syndrome. The symptoms of this condition include: failure to grow, developmental delays, facial abnormalities and skeletal joint abnormalities.

Caffeine: Caffeinated drinks should be taken in moderation Less than 200mg (about 2 cup of coffee) Increased caffeine intake increases the risk of first trimester spontaneous abortions. Mercury: Pregnant women should limit the consumption of: shark, mackerel, tilefish, and swordfish to no more than once a month. Seafood such as canned tuna, shrimp, salmon, cod, crabs and scallops all have very low levels of mercury and can be safely eaten.