The document provides guidance on conducting a thorough health history and physical examination for pregnant women. Key points discussed include: - Taking a medical history to understand any risk factors, including symptoms of pregnancy, prior complications, chronic illnesses, toxic exposures, nutrition, and social support. - Performing a physical exam involving inspection of general health, vital signs, breasts, abdomen, genitalia and cervix. Abdominal exam allows assessing fetal size and position through palpation and auscultation of the fetal heart. - Guidance is given on measuring fundal height, assessing uterine contractility, and performing a bimanual and speculum exam in a manner appropriate for pregnancy. The goal

1. THE PREGNANT WOMAN:
THE HEALTH HISTORY
Sánchez Alfaro Ober J.
ober_1_9@hotmail.com

5. The Health History
• Common or Concerning Symptoms
• Symptoms of pregnancy
• Toxic exposures, use of illicit drugs, domestic
violence
• Prior compilations of pregnancy
• Chronic illnesses in patient or family members

6. • During the initial visit: the woman’s current
state of health and on risk factors for any
conditions that could adversely affect her or
the developing fetus.
• Ask about symptoms of pregnancy such as
breast tenderness, nauseas or vomiting,
urinary frequency, change in bowel habits,
and fatigue.

7. • Review:
•attitude toward the pregnancy, and if she
plans to continue to term.
•look into her eating patterns and quality of
nutrition. Does she smoke or drink alcohol?
What about her income and her social
support network?

8. • If she works, has there been any
exposure to:
•Teratogenic drugs or toxic
substances?
•What about any use of illicit drugs?
•Is there any history or domestic
violence that may escalate during
pregnancy?

9. • What about prior pregnancies, since past
obstetrical problems tend to recur?
• Has she has any major complications of
pregnancy or problems with labor or delivery?
Has she has a premature or growth-retarded
infant? Ask also about her past medical history,
especially and chronic diseases like hypertension,
diabetes, or cardiac conditions. You should also
review her family history for these conditions.

10. • In addition, the clinical should get information
needed for calculating the expected weeks of
gestation by dates.
• This is currently counted in weeks from either
(1) the first day of the last menstrual period
(LMP), known as menstrual age, or (2) the date
of conceptions, if this is known (conception
age).

11. • Menstrual age is used most frequently to express
the weeks of gestation calculated by dates. The
first day of the LMP is also used to calculate the
expect date of confinement (EDC) or projected
time of term labor and birth for women with
regular 28- to 30-day cycles.
The EDC can be determined by adding 7 days to
the first day of the LMP, subtracting 3 months,
and adding one year (Naegele’s rule).

13. TECHNIQUES OF EXAMINATION
• General inspection:
Inspect the overall health, nutritional status
neuromuscular coordination, and emotional
state as the woman walks into the exam
room and climbs on the examination table.

14. • Vital Signs and Weight:
Take the blood pressure. A baseline reading
helps to determine the woman’s usual
range. In midpregnancy, blood pressure is
normally lower than in the nonpregnant
state.
Measure the weight. First trimester weight,
loss related to nausea and vomiting is
common but should not exceed 5 pounds.

15. • Breasts:
•Inspect the breasts and nipples for symmetry
and color. The venous pattern may be marked,
the nipples and areolae are dark, and
Montgomery’s glands are prominent.
•Palpate for masses. During pregnancy, breasts
are tender and nodular.
•Compress each nipple between your index
finger and thumb. This maneuver may express
colostrum from the nipples.

16. • Abdomen:
•Position the pregnant woman in a semi-
sitting position with her knees flexed.
•Inspect any scars or striate the shape and
contour of the abdomen, and the fundal
height. Purplish striate and black line are
normal in pregnancy. The shape and contour
may indicate pregnancy size.

17. • Palpate the abdomen for:
•Organs or masses. The mass of pregnancy is
expected.
•Fetal movements. These can usually be felt
by the examiner after 24 weeks (and by the
mother at 18 – 20 weeks).

18. • Uterine contractility. The uterus contracts
irregularly after 12 weeks and often in
response to palpation during the third
trimester. The abdomen then feels tense or
firm to the examiner, and it is difficult to feel
fetal parts.
• If the hand is left resting on the fundal portion
of the uterus, the fingers will sense the
relaxation of the uterine muscle.

19. • Measure the fundal height
with a tape measure if the
woman is more than 20 week’s
pregnant. Holding the tape as
illustrated and following the
midline of the abdomen,
measure from the top of the
symphysis pubis to the top of
the uterine fundus.

20. • Auscultate the fetal heart, nothing its
rate (FHR), location and rhythm. Use
either:
•A doptone, with which the FHR is
audible after 12 weeks, or
•A fetoscope, with which it is
audible after 18 weeks.

21. Genitalia, Anus, and Rectum
• Inspect the external genitalia, nothing the
hair distribution, the color, and any scars.
Scars from an episiotomy, a perineal
incision to facilitate delivery of an infant, or
from perineal lacerations may be present
in multiparous women.
• Inspect the anus for hemorrhoids. If these
are present, note their size and location.
• Palpate Bartholin’s and Skene’s glands. No
discharge or tenderness should be present.
• Check for a cystocele or rectocele.

22. Speculum Examination
• Inspect the cervix for color, shape,
and healed lacerations. A porous
cervix may look irregular because of
lacerations.
• Take Pap smears and, if indicated,
other vaginal or cervical specimens.
The cervix may bleed more easily
when touched due to the
vasocongestion of pregnancy.
• Inspect the vaginal walls for color. A
bluish or violet color, deep rugae,
and an increased milky white
discharge, leucorrhea, are normal.

23. Bimanual Examination

24. MODIFIED LEOPOLD’S MANEUVERS

25. THANKS YOU FOR
YOUR ATTENTION