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Antenatal examination

Extracted from Survival Guide to Midwifery, 2nd Edition (2012) Diane M. Fraser and Margaret A. Cooper, Oxford; Churchill Livingstone: 2012. Courtesy Elsevier

An integral part of antenatal care is the physical examination of the pregnant woman. Prior to examination, her consent and comfort are primary considerations.

The examination should include:

Weight

  • All women should be weighed at booking, or asked their weight
  • If it is within the normal body mass index (BMI) range, repeated weighing is not recommended
  • Women with a BMI of >30kg/m2 or <18kg/m2 should be carefully monitored and offered nutritional counselling

Blood pressure

Blood pressure (BP) is taken to ascertain normality and provide a baseline reading for comparison throughout pregnancy.

  • Systolic BP may be falsely elevated if the woman is nervous or anxious; a full bladder can cause an increase in BP
  • The woman should be seated or resting in a lateral position on the couch when BP is taken
  • A systolic BP of 140mmHg or diastolic pressure of 90mmHg at booking is indicative of hypertension and will need careful monitoring throughout pregnancy

Urinalysis

  • At the first visit a midstream urine specimen (MSU) should be sent to the laboratory for culture to exclude asymptomatic bacteriuria
  • Urinalysis for proteinuria is performed at every visit

Blood tests

  • ABO blood group and Rhesus (Rh) factor
  • Full blood count
  • Venereal Disease Research Laboratory (VCRL) test
  • HIV antibodies
  • Rubella immune status
  • Hepatitis B screening
  • Investigations for other blood disorders e.g. sickle-cell disease in women and their partners of some ethnic groups

Abdominal examination

Abdominal examination is carried out to establish and affirm that fetal growth is consistent with gestational age during the progression of pregnancy.

Auscultation

Routine auscultation of the fetal heart is not recommended unless requested by the mother. Using a Pinard's stethoscope, the midwife should count beats per minute, which should be in the range of 110-160. The midwife should take the woman's pulse at the same time to be able to distinguish between the two. Using ultrasound equipment e.g. Sonicaid or Doppler enables the woman to hear the fetal heartbeat.

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