Pregnancy Examination

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GENERAL:

  • OEDEMA
  • IV – fluid/medication
  • HELLP: jaundice, petechiae, ecchymoses
  • Pallor: anaemia/Fe deficiency
  • Palmar erythema
  • Collapsing pulse
  • Nutritional deficiency

VITALS:

  • BP: Pre-eclampsia
  • PR:
  • Temp: UTI, Appendicitis
  • FWTU: protein (PE), glucose (gest diabetes), UTI

ABDOMEN:

  • INSPECT:
    • Gravid abdomen
    • Scars: LUSCS (Pfannensteil) Appx,
    • Striae
    • Fetal movements
  • PALPATE:
    • MEASURE: SFH
      • 20 wks = umbilicus
      • cm = weeks up to 36 (then drops into pelvis)
    • TONE: of uterus, Braxton-hicks
    • TENDERNESS
      • RUQ: HELLP, AFLP, Cholelithiasis, Cholecysitis
      • FLANK: pyelonephritis
      • RIF: appendicitis

FETAL ASSESSMENT: (NB: By 37 weeks, most fetuses will have settled into a cephalic presentation, but about 3% will still be a breech or transverse lie)

  • NUMBER OF FETUSES:
  • LIE: oblique, transverse/horizontal, longitudinal/vertical
    • PRESENTATION: breech, cephalic
    • FETAL BACK: right, left, facing up, facing down
  • ENGAGED: when only 2/5 of cephalic part palpable, should be
    • engaged by ≥ 36 weeks, if not may have CPD
  • FETAL MOVEMENTS
  • LIQUOR ESTIMATION

AUSCULTATE:

  • FHR: doppler
  • Bowel sounds

LEGS:

  • OEDEMA
  • DVT
  • VARICOSE VEINS

CHEST:

  • Thyroid enlargement
  • Breast lump
  • Functional heart murmur

VAGINAL EXAMINATION

  • INDICATIONS:
    • Normal labor/ROM
      • To assess cervical dilation – done by midwife
  • CONTRAINDICATIONS:
    • 3rd trimester APH (without exclusion of placenta praevia by U/S)

LARGE FOR DATES:

  • Think:MULTIPLE GESTATION
    • ABRUPTION
    • Polyhydramnios
    • Diabetes

SMALL FOR DATES:

INVESTIGATIONS:

MATERNAL BLOOD GROUP

  • Group B Strept status

HELLP:

  • FBE, U&E, LFT, Coags

FETAL MONITORING:

  • CTG