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APPROACH TO AN OBSTETRIC PATIENT

APPROACH TO AN OBSTETRIC PATIENT. HISTORY. HISTORY TAKING IS AN ART – ENQUIRE REGARDING THE WELL- BEING OF MOTHER AS WELL AS FETUS HISTROY OF PAST PREGENCY – MAY ALTER THE OUTCOME OF PRESENT PREGNANCY. PARTICULARS OF THE PATIENTS. NAME AGE ADDRESS MARITAL STATUS DATE OF ADMISSION

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APPROACH TO AN OBSTETRIC PATIENT

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  1. APPROACH TO AN OBSTETRIC PATIENT

  2. HISTORY • HISTORY TAKING IS AN ART – ENQUIRE REGARDING THE WELL- BEING OF MOTHER AS WELL AS FETUS • HISTROY OF PAST PREGENCY – MAY ALTER THE OUTCOME OF PRESENT PREGNANCY

  3. PARTICULARS OF THE PATIENTS • NAME • AGE • ADDRESS • MARITAL STATUS • DATE OF ADMISSION • DATE OF EXAMINATION • GRAVIDA & PARITY

  4. CHIEF COMPLAINTS • CHIEF COMPLAINTS WITH DURATION IN CHRONOLOGICAL ORDER IN PATIENTS LANGUAGE • MAY PRESENT WITH : • AMENORRHOEA • SYMPTOMS RELATED TO PREGNANCY • ANKLE OEDEMA

  5. CHIEF COMPLAINTS • MAY PRESENT WITH : • PAIN IN THE ABDOMEN • BACKACHE • BLEEDING IN PREGNANCY: EARLY / LATE • LESS FETAL MOVEMENT • UNDUE ENLARGEMENT OF THE ABDOMEN • VAGINAL DISCHARGE

  6. HISTORY OF PRESENT ILLNESS 1. AMENORRHOEA: Expressed in weeks, Calculated from LMP Diagnosis of pregnancy confirmed??? 2. SYMPTOMS RELATED TO PREGNANCY: NAUSEA & VOMITING FREQUENCY OF MICTURATION

  7. HISTORY OF PRESENT ILLNESS 2. SYMPTOMS RELATED TO PREGNANCY: CONSTIPATION HEAVINESS IN THE BREAST RISE OF TEMPERATURE 3. ANKLE OEDEMA: PRESSURE DUE TO GRAVID UTERUS ? HTN, ??? Protein Urea

  8. HISTORY OF PRESENT ILLNESS 4. PAIN ABDOMEN: LABOUR PAIN ABRUPTIO PLACENTAE PRE-ECLAMPSIA TOXEMIA DEGENERATION OF MYOMA ACUTE URINARY RETENSION TORSION OF OVARIAN CYST ACUTE CHOLECYSTITIS

  9. HISTORY OF PRESENT ILLNESS 5.BACKACHE: INCREASE IN BODY WEIGHT HYPER EXTENSION OF SPINE LAXITY OF JOINTS IN PELVIS AND SPINE 6. VAGINAL BLEEDING: Implantation Haemorrhage, Abortion, Ectopic Pregnancy, H.mole, Placenta Previa Abruptio Placenta

  10. HISTORY OF PRESENT ILLNESS 7.LESS FETAL MOVEMENT: 10/ 12 hrs PRIMI: 18 weeks MULTI: 16 weeks 8.UNDUE ENLARGEMENT OF THE ABDOMEN: MULTIPLE PREGNANCY, HYDRAMNIOS, ABRUPTIO PLACENTA, MACROSOMIA, MISTAKEN DATE

  11. HISTORY OF PRESENT ILLNESS 9.VAGINAL DISCHARGE: RUPTURE OF MEMBRANE PHYSIOLOGICAL LEUCORRHOEA CANDIDIASIS CERVICITIS 10.HISTORY OF TT/ IRON+ CA SUPPLIMENT

  12. HISTORY OF PAST ILLNESS • PAST MEDICAL HISTORY • PAST SURGICAL HISTORY • HTN, DM, PTB, ASTHAMA FAMILY HISTORY PERSONAL HISTORY DRUG HISTORY

  13. MENSTRUAL HISTORY • AGE OF MENARCHE • MENSTRUAL CYCLE • MENSTRUAL PERIOD • LMP • DYSMENORRHOEA CONTRACEPTIVE HISTORY

  14. OBSTETRICAL HISTORY

  15. PHYSICAL EXAMINATION • GENERAL PHYSICAL EXAMINATION : APPEARANCE HEIGHT WEIGHT • PALLOR, ICTERUS, LYMPH NODES, CYANOSIS, CLUBBING, OEDEMA, DEHYDRATION

  16. PHYSICAL EXAMINATION • VITAL SIGNS : PULSE BLOOD PRESSURE RESPIRATORY RATE TEMPERATURE • BREAST EXAMINATION

  17. ABDOMINAL EXAMINATION • INSPECTION: SHAPE, SCAR MARKS, VENOUS ENGORGEMENT, STRIAE GRAVIDARUM, LINEA NIGRA • PALPATION: SUPERFICIAL PALPATION: TEMPERATURE, TENDERNESS

  18. ABDOMINAL EXAMINATION • PALPATION: FUNDAL HEIGHT FUNDAL GRIP LATERAL GRIP FIRST PELVIC GRIP SECOND PELVIC GRIP: PAWLIK’S GRIP

  19. FUNDAL GRIP

  20. LATERAL GRIP

  21. FIRST PELVIC GRIP

  22. SECOND PELVIC : PAWLIK’S GRIP

  23. ABDOMINAL EXAMINATION • AUSCULTATION: FHS: 120-160 beats / min FETAL TACCHYCARDIA: FEVER, DISTRESS FETAL BRADYCARDIA: CARDIAC ANOMALY

  24. PELVIC EXAMINATION • PRE-REQUISITS: EXPLANATION EMPTY BLADDER DORSAL POSITION FULL ASEPSIS

  25. PELVIC EXAMINATION • INDICATIONS: EARLY PREGNNCY: DIAGNOSIS ASSESS PELVIS ADEQUACY DURING LABOUR: ASSESSMENT OF PROGRSS OF LABOUR CONFIRM THE PRESENTATION

  26. INVESTIGATIONS • DIAGNOSIS:PREGNANCY KIT • Hb estimation • BLOOD GROUPING • URINE R/M/E and URINE C/S(if signs of infection) • VDRL(both partners) • BLOOD SUGAR • HIV, HEPATITIS • USG

  27. GENERAL OBSTETRICAL TREATMENT

  28. THANK YOU!!!

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