- 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.
- Temperature: Fever may indicate infection.
- Pulse: Possible causes of tachycardia in a pregnant patient maybe due to anxiety, fever (due to a TORCH infection) or anemia.
- 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.
- Edema: Pedal edema is normal in late pregnancy.
- Lymph nodes
- Check for breast tenderness.
- Check for the presence of lumps.
- Identify any nipple deformities/problems that may interfere with breast feeding.
Exposure: Must be up to pubic symphysis so that the Pfenenstiel’s scar (if present) is clearly visible.
- Make sure that abdominal distention is consistent with the period of gestation.
- Check for the presence of any scars, pigmentation, or visible pulsations.
- Can fetal movements be seen?
- Palpate the liver, spleen and kidneys.
- Liver span
- Fluid thrill
- Shifting dullness
Antenatal Obstetric Examintation:
- 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.
- Check the lie of the baby: Relationship between the long axis of the maternal and fetal spine.
- Presentation (Breech, Cephalic, Shoulder)
- 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.
- Listen to fetal heart sounds
- Leopole’s Maneuver: Fundal grip, Lateral grip, Pelvic grip, Pawlik’s grip.