Antenatal Examination

Antenatal Examination

General Physical

  1. BP: usually falls during the first 2 trimesters. The decrease in diastolic blood pressure is greater than the decrease in systolic BP. Pregnancy related hypertension is after 20 weeks of gestation.
  2. Temperature: Fever may indicate infection.
  3. Pulse: Possible causes of tachycardia in a pregnant patient maybe due to anxiety, fever (due to a TORCH infection) or anemia.
  4. Respiratory Rate: Increases in pregnancy because of metabolic acidosis. And in late pregnancy the increase is due to the compression of the diaphragm by the enlarged uterus.
  5. Jaundice
  6. Anemia
  7. Cyanosis
  8. Edema: Pedal edema is normal in late pregnancy.
  9. Lymph nodes

Breast Examination

  1. Check for breast tenderness.
  2. Check for the presence of lumps.
  3. Identify any nipple deformities/problems that may interfere with breast feeding.

Abdominal Examination

Exposure: Must be up to pubic symphysis so that the Pfenenstiel’s scar (if present) is clearly visible.

Inspection:

  1. Make sure that abdominal distention is consistent with the period of gestation.
  2. Check for the presence of any scars, pigmentation, or visible pulsations.
  3. Can fetal movements be seen?

Palpation:

  1. Guarding
  2. Rigidity
  3. Tenderness
  4. Palpate the liver, spleen and kidneys.

Percussion:

  1. Liver span
  2. Fluid thrill
  3. Shifting dullness

Antenatal Obstetric Examintation:

  1. Measure the symphysio-fundal height: Move your hand down from the xiphoid process to the first area of resistance. Measure this in Inches and then convert it into centimeters.

Note: After 14 weeks gestation the symphysio-fundal height in centimeters = Number of weeks of gestation + 3 cm.

  1. Check the lie of the baby: Relationship between the long axis of the maternal and fetal spine.
  2. Presentation (Breech, Cephalic, Shoulder)
  3. Engagement of the fetal head: When the widest part of the fetal head has crossed the pelvic brim, the head is said to be engaged.
  4. Listen to fetal heart sounds
  5. Leopole’s Maneuver: Fundal grip, Lateral grip, Pelvic grip, Pawlik’s grip.

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