ANTENATAL ASSESSMENT

1.BIODATA :

Name :

Age :

Date of admission :

Ip No :

Diagnosis :

LMP :

EDD :

POG :

2. REASON FOR ADMISSION :

3.PRESENT OBSTETRICAL HISTORY

4.ANTENATAL HISTORY

a)1st trimester :

b)2nd trimester :

c)3rd trimester :
5.PAST OBSTETRICAL HISTORY

SL Date of Place Duration Method Course of Labour puerparium Baby

NO. delivery of of of pregnancy
birth pregnancy delivery

6.FAMILY HISTORY

7.MEDICAL SURGICAL HISTORY:

8.NUTRITIONAL HISTORY :

9.SOCIO-ECONOMIC HISTORY :

10.PHYSICAL ASSESSMENT

a)General appearance :

Body built :

Nourishment :
b) Weight :

Height :

c) vital signs

 Temperature :
 Pulse :
 Respiration :
 Blood pressure :

d) Head :

Scalp :

Hair :

e) Eyes :

f)Face :

Nose :

g) Mouth :

h) Ears :

i) Neck :

k)Breast

Inspection :

Palpation :

11.OBSTETRICAL EXAMINATION

Abdominal examination

Expose the whole abdomen till symphysis pubis

Inspection:

Size of the abdomen :

Shape of the abdomen :

Contour of abdomen :

Fetal movements :

Umbilicus :

Bladder :

Skin changes :

Palpation

Symphysio- fundal height :

Abdominal girth :

OBSTETRIC GRIPS (LEOPOLD MANEUVER)

1.Fundal grip (1st Leopold)

2.Lateral grip (2nd Leopold)

3.Pelvic grip (pelvic palpation)

4.Pawlick grip(second pelvic grip)4th leopod

Auscultation :

12.Genitalia :

13.Extrimities :