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Initial Assessment (Anamnesis)

• To assess levels of health by taking a detailed history


and to offer appropriate screening tests
• To ascertain baseline recordings of blood pressure,
urinalysis,
• To identify risk factors by taking accurate details of past
and present midwifery, obstetric, medical, family and
personal history
• To provide an opportunity for the woman to express and
discuss any concerns
• To give public health advice
• To build a trusting relationship with pregnant women
General Assesment
• 1. Vital sign, nutrition, abnormality of body
shape.
• 2. Checking for anemia, cyanose, oedema
(toxaemia gravidarum), cardiac and
pulmo.
• 3. Blood Pressure
• 4. Weight
Laboratorium Assesment
1. Urine : glucose, albumin or sedimen.
Indication: Nefritis, TG
2. Blood: checking for Hb, deficiency of Fe,
serology reaction and blood glucose
3. Faeces
Abdominal examination & pelvic
examination
• In the initial presentation, full physical
examination should be done.
• Abdominal & pelvic examination remains
important exam for pregnant women because it is
the easiest method of fetal monitoring.
• Abdominal examination is carried out from
25 weeks' gestation to establish and affirm
that fetal growth is consistent with
gestational age during the pregnancy.
• The specific aims are to:
• • observe the signs of pregnancy
• • assess fetal size and growth
• • auscultate the fetal heart when indicated
• • locate fetal parts
• • detect any deviation from normal.
Methods of examination

• 1- Inspection
– Size of the uterus: assess
• If the length & breadth are both increased 
multiple pregnancies, polyhydramnios
• If the length is increased only  large baby
– Shape of the uterus: length should be larger than
broad this indicates longitudinal lie. But if the uterus
is low and broad indicates transverse fetus lie.
– Fetal movement
– Contour of the abdomen: full bladder may be
visible in late pregnancy. Umbilicus may become
everted
– Skin changes: look for stretch marks, linea nigra,
scars that indicates previous surgeries
Methods of examination

• 2- Palpation (A) : by Leopold maneuver-4


maneuvers
– Palpate the fundus (to determine if it contains breech,
head)
• By gentle pressure:
– if soft consistency/ indefinite outline  breech
– If hard, smooth, well defined  head
• Move your fingertips over the fetal mass to
determine mobility and sixe
– If can’t move independent from the body 
breech
– If moves freely between fingertips  head
Essential definitions that you should know to
understand the physical examination
findings:
• The presentation:
is the part of the
fetus in the lower
pole of the uterus
overlying the pelvic
brim (cephalic,
breech)
• The lie of the fetus: is the relation of the
long axis of the fetus to the uterus (could
be longitudinal, oblique or transverse. only
longitudinal lie is normal)
• The attitude: is the posture of the fetus
(flexion, deflexion, extension)
• The position: of
the baby in relation
to the presenting
part of the mother’s
pelvis. It is
expressed
according to the
denominator which
is :
• occiput in vertex
presentation
• sacrum in breech
presentation
• mentum in face
presentation
Station & engagement
Station: is the relation of
the presenting part to the
ischial spine. If the
presenting part is at the
level of ischial spine,
station =0
Engagement: the descent
of the biparietal diameter
through pelvic brim. If the
head is at the level of
ischial spine the head
must be engaged.
Method of abdominal exam
• Lateral Palpation (B): (determine the position of
the fetal back and small parts)
• Hands are placed on each side of the umbilicus.
The fetal spine will palpate as firm, flat and
linear. The fetal extremities are palpable by their
varying contour and movements. The purpose of
this maneuver is to determine whether the fetal
back is left or right.
Method of abdominal exam
• Pelvic palpation (C): 2 maneuvers
• Grasp the lower poles of the uterus between fingers
and thumbs and comment of the size, flexion and
mobility of the head.
• To determine the position of the vertex presentation: try
to palpate the prominences (occiput @ the same side
of the back & sincipital @ the opposite side of the
back)
Pawlik's manoeuvre, where the midwife grasps the lower pole of the uterus
between her fingers and thumb, which should be spread wide enough apart to
accommodate the fetal head
Method of abdominal exam
• 3- Auscultation: help assess fetal well being
Auscult the whole abdomen trying to locate the point
of maximum intensity.
Frequency: 120-140x/minutes
After you examine a pregnant women
you should answer the following
questions
1. What is the fundal
height?
It is estimated by
centimeters from
upper border of the
fundus to the pubis
symphasis by taping
measure. The
height of the fundus
correlates well with
the gestational age
especially during the
weeks of
pregnancy.
2. Lie of the fetus: only longitudinal lie is normal
3. Attitude: normally it is full flexion and every fetal
joint is flexed.
4. presentation: normally cephalic
5. position: according to the dominator
6. Is the vertex engaged?