Obstetrics Physical Examination Flashcards
(14 cards)
Obstetric physical examination?
INSPECTION
VITAL SIGNS
HANDS
HEAD AND NECK
BREAST
CHEST
LUNGS
HEART
Inspection?
From end of bed then to the right side of the patient :
1. General
2. nutritional status
3. Any respiratory distress
4. obvious things with the patient like catheter, cannula, Oxygen therapy
Vital signs?
- Blood pressure
- pulse (rate,rhythm,character, volume)
- respiratory rate
- temperature
- Oxygen saturations
- urine output
- GCS
- AVPU
- pupil reflex may be added.
- Value, units of measurement, comment whether normal or abnormal.
Hands?
- Pink/pale palms
- capillary refill time
- leuconychia
- koilonychia
Head and neck?
- Eyes - Pink/pale conjunctiva, any jaundice
- Mouth - Pink/pale and wet/dry mucous, membranes, aphthous mouth ulcers, glossitis, angular stomatitis, oral thrush, palatal Kaposi sarcoma.
- Neck - Lymphadenopathy (Submental, submandibular, preauricular, anterior cervical, supraclavicular, postauricular, posterior cervical), thyroid gland enlarged?
Breast exam?
- Any engorgement, abscess, cellulitis, nipple discharges, nipple retraction, skin colour change, asymmetry.
- If shaperon present then palpate for tenderness, masses, warmth
Chest?
Deformity, scars
Lungs?
- Inspection – Deformity, scars, tatoos, dyspnoeia,
- Palpation – Chest expansion, tactile vocal fremitus
- Percusion – In all zones anterioly and posteriorly for areas of resonance, dullness.
- Auscultation – Normal vesicular breath sounds/ bronchial breath sounds, transmitted sounds, wheezes, stridor, no breath sounds, vocal resonance
NB : Auscultation suffice if no respiratory problem/s in history.
Heart?
- Inspection – Hyperdynamic praecordium (heaves), scars, raised JVP
- Palpation – Palpable murmur (thrill), apex beat in 5th ICS MCL.
- Auscultation – S1+S2+0, any added heart sounds (S3, S4), murmurs, muffled heart sounds.
NB : Auscultation suffice if no cardiovascular problem/s in history
Obs abdominal exam - inspection?
- Abdomen enlarged and moving with respiration?/avoids in peritonitis
- linea nigra
- stria gravidarum
- stria albicans
- superficial veins
- pigmentation around the umbilicus
- inverted or flat or everted umbilicus
- surgical scars e.g C/S /laparotomy/laparoscopy scars, lie, obvious fetal movements.
Palpation?
LIGHT PALPATION
- Ask for any area of tenderness and start palpating away from the area of tenderness if any quadrant by quadrant.
- Palpate for liver, spleen or kidney enlargement
NB : Properties of an enlarged spleen : Cannot go above it but can go below it, has a notch on its medial aspect, moves with respiration, grows towards RLQ if no obstructing mass but towards LLQ if there is an obstructing mass
Leopold maneuvers - deep palpation?
- Fundal grip or 1st Leopold manoeuvre
– Height of fundus (SFH), fetal breech (soft rounded mass) in cephalic presentation or fetal head (hard rounded ballotable mass) in breech presentation. - Lateral grip or 2nd Leopold manoeuvre
– Foetal back (hard continuous mass), lie, size of fetus, fetal poles, amount of amniotic fluid. - Paulik grip or 3rd Leopold manoeuvre
– Nature and size of presenting part, degree of engangement of presenting part. - Deep pelvic grip or 4th Leopold manoeuvre
– Determine degree of flexion or extension of the fetal head, descent.
Percussion and Auscultation?
- PERCUSSION
– For liver and spleen - Auscultation
– Using Pinard Foetal Stethoscope (Fetoscope) over the fetus anterior shoulder.
- If multiple gestation then need 2 or more to listen to FHR at the same time.
Summary of obstetric history and examination?
- Summarize relevant obstetric History and Examination.
- Name, Age, gravidity, parity, GA, HIV and VDRL, PCs and any strong positive/s
- pink, nutritional status, vital signs, abdominal findings (SFH, lie, presentation, descent, FHR) and any significant positive findings.
