Professional Documents
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Naegles rule:
When first fetal movements were felt(quickening, in a primi gravida around 18-20/52, in multipara 16-
18/52
Admitted through OPD/ER on the date complaining of eg. Morning sickness, bleeding PV, abdominal
pain
Complicated birth:
Year
39/52
C.S for APH
Male/female
Alive
Weight
Post-op normal
Breast fed
Ex. 1986, C.S for APH, female baby alive 3kg, post op normal, breast fed
Abortion:
Year
Gestational age (eg. at 10/52)
Evacuation
Post Op complications
Ex. 1990, abortion at 10/52, evac, no post op complications
Ex.2: 1992, abortion at 22/52, D&E, no post op complications
&
HTc
DM
epilepsy
twins
TB
Malformations
Infertility
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Abnormal menstrual loss:
pattern, regular/ irregular
Amount of loss
# of pads or tampons used
passage of clots or flooding
any pain with the loss
Pelvic pain:
Site, Nature, Relation to periods, Aggravating and relieving factors, associated SS
Vaginal discharge:
Amount, color, odor, blood, rash, pain
"
Frequency of micturation increase d/t pressure and irritation. Urine retention is d/t the effect of
progesterone which relaxes the bladder muscles , and the rectum muscles leading to incomplete
emptying of the bladder and constipation. A high fiber diet is suggested and laxatives may be prescribed.
Ask about: incontinence (real or stress), urgency, dysurea, hematurea
Loin to groin pain
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G al:
Vital signs:
Pulse
BP
Temp
RR
Urine dip stick for protein and sugar
-
striae, kicking, bulges
size and shape:
midline fullness indicates ovarian or uterine mass. Fullness of flanks suggests ascites (confirm by fluid
thrill and shifting dullness), iliac fossa masses usually ovarian or bowel.
linea albicans/nigra, rash, pigmentation
? Rigidity or guarding
? Mass: position, size, shape, edges, mobility, consistency, fluid thrill if cystic
Malignant tumors usually fixed. Mobile tumors usually benign, but may be fixed by adhesions.
? The Fundus
? Fundal height:
from S.pubis uptil the fundus. If by calculation 38 and measure 26 it means there is either a
miscalculation of the EDD, or a problem with the fetus as IUGR. Also if the opposite, the
calculation<measured, it may suggest a macrosomic baby, twin pregnancy, polyhydramnios, hydropis
fetalis.
? Fundal grip:
to see whether the head or the buttocks are occupying the fundus.
Cephalic presentation
when the head is down and the buttocks occupy the fundus.
Breech presentation
is when the head occupies the fundus. This is significant esp in a primigravida where C-section is
preferred.
? Lateral grip:
important to assess how the baby is lying; whether transverse, oblique or longitudinal, the latter being
the only ideal position for delivery. It also tells whether the babys back is on the right or left.75% of
babys backs are on the left probably b/c of the liver on the right. This is necessary to find the site to
auscultate for the babys heart beat.
? First pelvic grip:
The only position with the back to the patient
Insert the fingers intelvis to see what part of the baby occupies the pelvis
? Second pelvic grip:
Move the part left and right , if mobile, then it is not in the pelvic brim, so no engagement has occurred
yet. If immobile it means that the BPD (biparietal diameter) of the baby is in the pelvic brim; i.e
engagement occurred. This palpation is necessary esp in primigravida b/c if 36 weeks passed and no
engagement occurred, it may suggest that the pelvis is too narrow, or the baby has hydrocephalus etc..
Dull masses are in sontact with the abdominal wall, while resonant suggest being behind the bowel
Bowel sounds, absent in ileus
Fetal heart: heard with stethoscope after 24/52, with portable sonicaide at 12/52
)-.-c/-c
Normal tomy
Vulva, Labia majora, labia minora,Clitoris
Look for ulcers, inflammation, growths or swellings
Inspect urethral orifice for discharge ( if present spread on thin film), redness or growth
Digital: use lubricant, left hand spreads labia insert right hand: palpate vaginal walls, growth, cyst, FB.
Then examine fornices check for obliteration or swelling. Cervix is examined next noting direction, size
and shape, surface smooth/irregular, size of external os, and growths or ulcerations
Bimanual: right inserted and left pushing on abdomen; to feel uterus ( if retroverted will not be felt
unless put fingers to posterior fornex). Determine size, mobility, and surrounding structure. Only
abnormal fallopian tubes are palpable. Ovaries may be felt as small mobile oval structures that are
sensitive to pressure
Positions:
- Left lateral
- Sims Semi-prone: good for external genitalia, Cervix and anterior vaginal wall, exposing the vaginal end
of the vesicovagianl fistula
- Dorsal: good for vulva, bimanual, most frequently use
- Lithotomy: best position for under anesthesia examination
Rectal examination:
Done in virgins, when PV is difficult
PAP smear:
R/O CIN cervical intraepithelial neoplasia
ULTRA SOUND:
Useful but not available every where
- measures the BPD
- measures the femoral length
this is accurate in the first 16 weeks. After 16 weeks it has a +/- 2 weeks accuracy
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