gynecology and obstetrics
Evaluation of the Obstetric Patient
Physical Examination
A full general examination, including blood pressure (BP), height, and weight, is done first. Body mass index (BMI) should be calculated and recorded. BP and weight should be measured at each prenatal visit. In the initial obstetric examination, speculum and bimanual pelvic examination is done for the following reasons: To check for lesions or discharge To note the color and consistency of the cervix To obtain cervical samples for testing Also, fetal heart rate and, in patients presenting later in pregnancy, lie of the fetus are assessed (see figure Leopold maneuver ). Pelvic capacity can be estimated clinically by evaluating various measurements with the middle finger during bimanual examination. If the distance from the underside of the pubic symphysis to the sacral promontory is>11.5 cm, the pelvic inlet is almost certainly adequate. Normally, distance between the ischial spines is≥9 cm, length of the sacrospinous ligaments is 4 to≥5 cm, and the subpubic arch is≥90°. During subsequent visits, BP and weight assessment is important. Obstetric examination focuses on uterine size, fundal height (in cm above the symphysis pubis), fetal heart rate and activity, and maternal diet, weight gain, and overall well-being. Speculum and bimanual examination is usually not needed unless vaginal discharge or bleeding, leakage of fluid, or pain is present. 