LESSON 4: Physical examination

INTRODUCTION
This is necessary in every visit so as to assess the maternal and foetal health.

LESSON CONTENT
Laboratory examinations: Height over 160 cm is an indication of a normal size pelvis. Physical examination – head to toe Inspect the head for cleanliness, lice and nits Face for oedema, eye for pallor and jaundice. Mouth – inspect tongue for pallor, sore and tooth decay. palpate the neck for enlarged glands. Breast : observe the shape, size and nipple (retraction/inverted/flat) palpate breast for masses and enlarged lymph nodes at the tail of breast. Upper extremities – for oedema, pallor of palms and nail bed. Lower extremities: inspect for oedema, varicose veins. Sacral region – for oedema.
 * urine/stool for routine examination
 * Haemoglobin estimation:Sickling test, blood groupRH factor
 * Blood pressure is taken to ascertain baseline reading for comparison throughout pregnancy

Specific Aims of abdominal examination PROCEDURE FOR PHYSICAL EXAMINATION Explain procedure to the woman. Ask the woman to empty bladder Provide privacy. Help the woman to lie on couch in dorsal position. Wash hands with soap and water and dry. Expose abdomen only. Warm hands by rubbing together Stand on the right side of the woman Inspect the abdomen for size and shape, previous scars, foetal movement. Measure       the    symphysio-fundal height. Locate the upper border of the symphsis pubis. Put the zero mark of the tape measure on the upper border of the symp hysis bis extend the tape along the contour of the abdomen along the midline to the fundus Note the measurement in centimetres.Palpate the menusing palms and pads rather than tips of fingers. Compare fundal height measurement with calculated gestational age to see if there is  size-date discrepancy. Ascultation – use foetal stethoscope to take foetal heart.
 * To assess foetal health
 * To observe for signs of pregnancy
 * To defect any deviation from normal
 * To assess foetal size and growth procedure.