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The Health History
• Common or Concerning Symptoms• Symptoms of pregnancy• Toxic exposures, use of illicit drugs, domestic
violence• Prior compilations of pregnancy• Chronic illnesses in patient or family members
• During the initial visit: the woman’s current state of health and on risk factors for any conditions that could adversely affect her or the developing fetus.
• Ask about symptoms of pregnancy such as breast tenderness, nauseas or vomiting, urinary frequency, change in bowel habits, and fatigue.
• Review:•attitude toward the pregnancy, and if she
plans to continue to term.• look into her eating patterns and quality of
nutrition. Does she smoke or drink alcohol? What about her income and her social support network?
• If she works, has there been any exposure to:• Teratogenic drugs or toxic substances?•What about any use of illicit drugs?• Is there any history or domestic
violence that may escalate during pregnancy?
• What about prior pregnancies, since past obstetrical problems tend to recur?
• Has she has any major complications of pregnancy or problems with labor or delivery? Has she has a premature or growth-retarded infant? Ask also about her past medical history, especially and chronic diseases like hypertension, diabetes, or cardiac conditions. You should also review her family history for these conditions.
• In addition, the clinical should get information needed for calculating the expected weeks of gestation by dates.
• This is currently counted in weeks from either (1) the first day of the last menstrual period (LMP), known as menstrual age, or (2) the date of conceptions, if this is known (conception age).
• Menstrual age is used most frequently to express the weeks of gestation calculated by dates. The first day of the LMP is also used to calculate the expect date of confinement (EDC) or projected time of term labor and birth for women with regular 28- to 30-day cycles.The EDC can be determined by adding 7 days to the first day of the LMP, subtracting 3 months, and adding one year (Naegele’s rule).
TECHNIQUES OF EXAMINATION
• General inspection:Inspect the overall health, nutritional status neuromuscular coordination, and emotional state as the woman walks into the exam room and climbs on the examination table.
• Vital Signs and Weight:Take the blood pressure. A baseline reading helps to determine the woman’s usual range. In midpregnancy, blood pressure is normally lower than in the nonpregnant state.Measure the weight. First trimester weight, loss related to nausea and vomiting is common but should not exceed 5 pounds.
• Breasts:• Inspect the breasts and nipples for symmetry and
color. The venous pattern may be marked, the nipples and areolae are dark, and Montgomery’s glands are prominent.• Palpate for masses. During pregnancy, breasts are
tender and nodular.•Compress each nipple between your index finger
and thumb. This maneuver may express colostrum from the nipples.
• Abdomen:•Position the pregnant woman in a semi-sitting position with her knees flexed.• Inspect any scars or striate the shape and contour of the abdomen, and the fundal height. Purplish striate and black line are normal in pregnancy. The shape and contour may indicate pregnancy size.
• Palpate the abdomen for:•Organs or masses. The mass of pregnancy is expected.•Fetal movements. These can usually be felt by the examiner after 24 weeks (and by the mother at 18 – 20 weeks).
• Uterine contractility. The uterus contracts irregularly after 12 weeks and often in response to palpation during the third trimester. The abdomen then feels tense or firm to the examiner, and it is difficult to feel fetal parts.
• If the hand is left resting on the fundal portion of the uterus, the fingers will sense the relaxation of the uterine muscle.
• Measure the fundal height with a tape measure if the woman is more than 20 week’s pregnant. Holding the tape as illustrated and following the midline of the abdomen, measure from the top of the symphysis pubis to the top of the uterine fundus.
• Auscultate the fetal heart, nothing its rate (FHR), location and rhythm. Use either:•A doptone, with which the FHR is
audible after 12 weeks, or•A fetoscope, with which it is
audible after 18 weeks.
Genitalia, Anus, and Rectum
• Inspect the external genitalia, nothing the hair distribution, the color, and any scars. Scars from an episiotomy, a perineal incision to facilitate delivery of an infant, or from perineal lacerations may be present in multiparous women.• Inspect the anus for hemorrhoids. If these
are present, note their size and location.•Palpate Bartholin’s and Skene’s glands. No
discharge or tenderness should be present.•Check for a cystocele or rectocele.
Speculum Examination• Inspect the cervix for color, shape,
and healed lacerations. A porous cervix may look irregular because of lacerations.• Take Pap smears and, if indicated,
other vaginal or cervical specimens. The cervix may bleed more easily when touched due to the vasocongestion of pregnancy.• Inspect the vaginal walls for color. A
bluish or violet color, deep rugae, and an increased milky white discharge, leucorrhea, are normal.
Bimanual Examination
MODIFIED LEOPOLD’S MANEUVERS
THANKS YOU FOR YOUR ATTENTION
