Antenatal Examination Flashcards
(18 cards)
How would you welcome Marsha to her appointment ?
Say hello, introduce yourself, state your role
Confirm name and DOB and compare with case notes.
Explain what the antenatal examination is and gain informed consent
Ensure Marsha is able to go ahead with examination and is not experiencing pain or bleeding
What is the purpose of antenatal care ?
To ensure maternal and fetal health and wellbeing
Look for any signs of deviations from normal and if found refer to appropriate person or department.
How would you prepare the room for antenatal examination ?
Ensure privacy and dignity in the space, able to close doors and shut curtains.
Ensure you have all equipment
How would you prepare yourself and what equipment do you need ?
I would need a sphygmomanometer, stethoscope for blood pressure, urinalysis sticks to dip urine, doptone, pinnard, doptone gel, single use measuring tape and case notes.
Wash hands following WHO 5 moments 7 steps hand hygiene.
Describe component parts of antenatal examination ?
1) holistic over view- asking open ended questions about wellbeing
2) blood pressure when sitting and calm to compare with booking blood pressure.
3) urine sample from the last hour to check for signs of UTI or protein in the urine which could indicate pre eclampsia or glucose which can be a sign of gestational diabetes.
4) observe for any signs of edema - swelling in the hands or feet or signs of a DVT.
5) abdominal examination - to assess feral growth and size, assess fetal health and determine fetal position.
Preparation and positioning of Marsha is important, explain how Marsha should prepare and what position she should adopt. Give reasons.
Empty bladder as a full bladder can affect measurement and be uncomfortable.
Lower bed or give assistance to adopt a semi recumbent position with a pillow or wedge to keep the weight of Gravid uterus away from large vessels.
This weight could cause a vena caval occlusion, this is when your gravid uterus compresses your vena cava and stops the Venus return.
What will the effect of inferior vena caval occlusion ?
Could suffer from supine hypertension
Can make you feel very dizzy and sick and can even become unconscious.
What would you do if Marsha becomes dizzy and why?
Ask Marsha to roll onto a left lateral position as this takes the weight of gravid uterus off the large vessels to allow Venus return.
I would stay in the room but call for help
Explain how you would perform an abdominal examination, explain in detail what you would do and why ?
Ask Marsha for consent, ask her to lift her top to expose abdomen.
Inspect abdomen looking at the shape and size. If this is her first baby we would expect the uterus to look more egg shaped. For a paras women uterus can look more round due to tone of uterine muscles.
Look for any rashes, previous scars, stretch marks or bruises.
Fundal height measurement ?
We use this to estimate gestation, measured in cm and should match weeks in gestation.
Measure from top of the uterus down to the symphysis pubis.
Use single use tape measure with the blank side facing so there are no bias measurements.
Use side of hand to feel for firm curves part of the uterus, ensure tape measure is at 0 hold in position and measure to symphysis pubis
What are the reasons for fundal palpation ?
To try and determine what is located in the upper area of the uterus find presentation of the fetus
Start at the side keeping fingertips close together and gently press till you feel something and try to detect whether it is firm like a head or soft like a buttocks.
Lateral palpation ?
Anchor uterus with one hand
With the other hand gently work way down the sides looking to feel softness, texture to detect limbs or the back of the fetus
Pelvic palpation?
Turn away from the mother, place two hands above symphysis pubis and ask mother to take a big deep breath in and press inwards on release to see how much of the fetal head you can feel being engaged.
When would you expect the head to become engaged ?
36 weeks for a primigravida
For paras or multiparas women, any time up until the onset of labour
Auscultation?
Not always necessary but can do so with maternal request.
I will listen to the FH over the posterior angle of the anterior shoulder as this is where it is the loudest.
Large area of the pinnard goes on the skin and ear goes on small area.
Then use watch or clock to found FH for one full minute
Normal range is between 110-160bpm checking for rate, Rythm and regularity
How would you distinguish between the fetal and maternal FH?
Hold mothers wrist to feel radial pulse at the same time as the maternal HR is slower 60-100bpm
Following abdominal examination what would your actions be ?
Give Marsha a hand to get comfortable, discuss findings.
Answer any questions,
Dispose of any single use equipment and PPE and wash hands.
Document
What findings would you document ?
Date, time, sign, gestation, size, lie, presentation, engagement, FH and movement
