[09.31] Physical Examination of Pregnant Women V2

Age of gestation (AOG)

What is asked in history-taking during the examination of a pregnant woman?

Last menstrual period (LMP) and first trimester ultrasound

What are the most reliable methods for determining AOG?

Gravida

What does "G" stand for in the obstetric score?

Number of pregnancies, including the current pregnancy

What does Gravida mean?

Para

What does "P" stand for in the obstetric score?

Number of viable births that reached ≥20 weeks

What does Para mean?

Term, Preterm, Abortion/Miscarriage, Live

What does TPAL stand for?

Count per baby of each pregnancy

What does TPAL mean?

Counted separately

In scoring TPAL, how are babies in multifetal pregnancies (twins, triplets, etc.) counted?

Blood pressure, weight, temperature, fundic height measurement, Leopold’s maneuver, and fetal heart tones

What measures are taken during an obstetric physical examination?

Empty bladder

What must the patient do prior to the examination to avoid discomfort or displacement of the uterus?

To move up the uterus for measurement

Why must the patient's knees be bent during the examination?

Inspect the abdomen

What is the first step after positioning the patient properly?

Incisitions, scars, striae gravidarum (stretch marks)

What should you inspect the abdomen for?

Previous cesarean section

What can the presence of a midline incisional scar indicate?

22-34 weeks AOG

When is fundic height measurement usually done?

Amniotic fluid volume and growth of the fetus

What is monitored through fundic height measurement?

Symphysis pubis

Where should the 0 cm mark be placed when measuring fundic height?

Palpate for the fundus

What should you do prior to taking fundic height measurement to help identify where to place the other end of the tape measure?

Disinfect and warm your hands

What should you do before palpating the abdomen?

Observe the patient’s reaction for any pain or ask her to let you know palpation is already painful

How do you know how much pressure to apply during palpation?

Raised or pressed down

When measuring fundic height, the tape measure may be ____ on the fundus

To the midline

Where should the uterus be gently pushed to obtain accurate fundic height measurement?

Cephalic pole (fetal head)

What is felt as a hard round, ballotable or moveable mass during LM1 (Fundal Grip)?

Podalic pole (breech)

What is usually seen as a large, nodular, immobile mass during LM1 (Fundal Grip)?

Longitudinal, transverse, or oblique

What types of fetal lie are identified by LM1 (Fundal Grip)?

Assess the uterine fundus

What is LM1 used to assess?

Towards the head of the patient

Which way should the examiner face during LM1, LM2, and LM3?

Fetal back and extremities location (maternal left or right), fetal heart tones

What does LM2 (Umbilical Grip) identify?

Rounded and firm

How does the fetal back feel upon palpation during LM2 (Umbilical Grip)?

Empty or hollow

How do the fetal extremities feel upon palpation during LM2 (Umbilical Grip)?

110-160 bpm

What is the normal expected range for fetal heart tones?

Bell of the stethoscope

What part of the stethoscope is used to listen for fetal heart tones?

The part of the fetus nearest the birth canal

What is the presenting part?

Confirms the fetal pole presenting or fetal presentation (whether cephalic or breech)

What does LM3 (Pawlik's Grip) confirm?

Fetal lie

Besides fetal presentation, what else does LM3 help determine?

What occupies the maternal pelvis?

What question does LM3 answer?

A movable mass that can be dislodged

How does an unengaged presenting part feel upon palpation?

A mass that is already fixed or immobile

How does an engaged presenting part feel upon palpation?

Degree of descent or the fetal attitude

What does LM4 (Pelvic Grip) determine?

Whether the fetal head is flexed or extended

What does LM4 determine about the fetal head?

Towards the legs of the patient

Which way should the examiner face during LM4?

Hypogastric area

Where does palpation occur during LM4?

Still floating

At 27 weeks, is there engagement of the head?

Flexed

If the head is ____ (nakayuko/nakatungo), the cephalic prominence is felt on the opposite side of the fetal back

Extended or hyperextended

If the head is ____ (nakatingala), the cephalic prominence will be felt at the same side of the fetal back

Fundic height, LM1, LM2, LM3, LM4

What should be included in reporting and final assessment?

The fundus

LM1 assesses which part of the uterus?

False

T/F: In LM2, the fetal back feels nodular

Fetal position

Which among the following is not confirmed or determined by LM3: Pawlik’s grip?

Waist circumference

Which of the following is NOT measured in an obstetric physical examination?

False

T/F: All Leopold’s maneuvers are carried out with the examiner facing toward the head of the patient.

LM2: Umbilical grip

Upon palpation, the examiner determined that the fetal small parts are located on the maternal left side, while the fetal heart tones can be heard in the maternal right. Which among the Leopold’s maneuvers was likely used?

22-34 weeks

Using the fundic height measurement to measure the AOG, during what weeks can it be done?