Documente Academic
Documente Profesional
Documente Cultură
In the initial presentation, full physical examination should be done. Abdominal & pelvic examination remains important exam for pregnant women because it is the easiest method of fetal monitoring.
Essential definitions that you should know to understand the physical examination findings: The presentation: is the part of the fetus in the lower pole of the uterus overlying the pelvic brim (cephalic, breech)
The lie of the fetus: is the relation of the long axis of the fetus to the uterus (could be longitudinal, oblique or transverse. only longitudinal lie is normal)
The position: of the baby in relation to the presenting part of the mothers pelvis. It is expressed according to the denominator which is : occiput in vertex presentation sacrum in breech presentation mentum in face presentation
Station & engagement Station: is the relation of the presenting part to the ischial spine. If the presenting part is at the level of ischial spine, station =0 Engagement: the descent of the biparietal diameter through pelvic brim. If the head is at the level of ischial spine the head must be engaged.
Skin changes: look for stretch marks, linea nigra, scars that
indicates previous surgeries
Move your fingertips over the fetal mass to determine mobility and sixe
If cant move independent from the body breech If moves freely between fingertips head
occiput
siniciput)
After you examine a pregnant women you should answer the following questions
1. What is the fundal height? It is estimated by centimeters from upper border of the fundus to the pubis symphasis by taping measure. The height of the fundus correlates well with the gestational age especially during the weeks of pregnancy.
After you examine a pregnant women you should answer the following questions
2. lie of the fetus: only longitudinal lie is normal
3. Attitude: normally it is full flexion and every fetal joint is flexed. 4. presentation: normally cephalic 5. position: according to the dominator
6. Is the vertex engaged?
3. Effacement of the cervix: thinning of the cervix (%) or length (cm). The cervix is normally 3-5 cms. If cervix is about 2 cm from external to internal os 50% effaced
50% effaced 100% effaced
4. Consistency of the cervix: soft vs. hard. During labor the cervix becomes soft. 5. Position of the cervix: posterior vs. anterior. During labor the cervix changes from posterior to anterior. 6. Membrane is intact or ruptured: assessed by fluid collection in the vagina