Aims for performing obstetrical examination –
• Access the general condition of the lady and the foetus
• Detect the complications
• Confirm the diagnosis
• Access the severity of condition of woman
• Evaluate expected date of delivery (EDD)
• Recognize high risk pregnancies
• Immunization against tetanus toxoid
• Education regarding breast feeding
• Counseling regarding contraceptive methods
ANTENATAL VISITS:
Pregnant lady requires routine antenatal visits to have access to health of mother and the baby. According to WHO, at least 4 antenatal visits are required. First visit being within first 16 weeks, second between 16-28 weeks, third visit at 32 weeks and fourth being at 36 weeks.
General examination consists of –
• Facial appearance
• Temperature
• Pallor
• Icterus
• Cyanosis
• Blood pressure
• Pulse rate
• Edema
Systemic examination consists of –
• Respiratory system examination
• Cardiovascular system examination
• Central nervous system examination
• Musculoskeletal system examination
Breast Examination:
Some changes which are suggestive of pregnancy are –
• Increased size and vascularity
• Pigmentation of areola
• Montgomery’s tubercles
• Protactile nipples
• Retraction of nipples (should be corrected)
Abdominal Examination:
Abdominal examination is done to –
• detect the period of gestation
• evaluate the size of the foetus
• detecting the lie of the foetus
• detecting the attitude of the foetus
• detecting the position of the foetus
• detecting uterine contractions
• evaluate foetal well being by listening to foetal heart sounds
• assess level of presenting part
Examination of abdomen is done by inspection of abdomen (presence of striae gravidarum, linea nigra or scars of previous surgery, etc.) and palpation of abdomen gently starting from an area where patient has no pain. The uterus is first palpable at 12 weeks of gestation.
Obstetric Grips:
There are four obstetric grips –
A) Fundal Grip – Examiner places both of his hands on the uterine fundus facing pregnant lady and tries to feel the presentation of the foetus.
B) Lateral Grip (Umbilical Grip) – Examiner places hands on flanks on either side of umbilicus. One hand steadies the foetus while the other palpates the foetus.
C) First Pelvic Grip – Examiner places the right thumb and forefingers over the lower pole with ulnar border on the pubis symphysis and the presenting part is grasped and moved side to side.
D) Second Pelvic Grip (Pawlik Grip) – Examiner places either hand on the lower abdomen by facing the feet of the pregnant lady and palpate the cephalic pole and feel the occiput and the sinciput.
Pelvic Examination:
Pelvic examination consists of inspection of the external genitalia, speculum examination of vagina and cervix and a bimanual pelvic examination.
Bimanual Pelvic Examination:
It is done to check woman’s internal pelvic organs. It is done by placing one hand on the lower abdomen and lubricated index and middle fingers of other hand are inserted into the vagina.
Contributor- Medico Eshika Keshari