#obgyn

First Prenatal Visit Physical Examination
1. General: [...]
2. Head and Neck:
• thyroid exam
• chloasma
• gums/mucous membranes: hyperemic/swollen; epulis of pregnancy
3. Chest:
• consider anatomic and physiologic effects of pregnancy
• elevated diaphragm
4. Heart:
• increased heart rate
• murmurs: flow versus possible pathologic
• if murmur is pathologic, consider maternal tolerance of pregnancy, echocardiogram, need for antibiotics for endocarditis prophylaxis during labour
5. Breast:
• leakage
• physiologic changes
6. Abdomen:
• striae
• linea nigra
• rectus diastasis
• uterus
7. Pelvic Examination:
• External Genitalia Inspection:
---• lesions: condyloma, ulcers, varicosities
---• previous surgeries: female genital mutilation
• Internal Genitalia:
---• Speculum Exam
• Inspection:
---• Vagina:
------• Chadwick’s sign (bluish discoloration)
------• vaginitis (yeast is common)
---• Cervix:
------• Ectropion
------• Polyps

• Cultures:

---• Chlamydial culture is taken from just inside the external os
---• Gonorrheal culture from os/cervix
• Pap:
---• Do not use intracervical brush during pregnancy - spatula or external brush only
• The cervix is often friable during pregnancy and may bleed from Pap - reassure patient that you are nowhere near the pregnancy and that spotting is normal after a Pap smear in pregnancy
• Bimanual Examination:
---• largely replaced by first trimester ultrasound.
---• Cervix: Hegar’s sign (softening)
• Uterus
---• size (ensure it is consistent with dates)
---• shape (expect it to be symmetrically enlarged)
---• consistency (expect soft)
---• if the uterus is firm, smaller than expected, irregularly enlarged, then reconsider dates, viability, uterine anomaly, ectopic pregnancy
• Adnexa: masses, their size, shape, consistency, mobility, tenderness
• Bony pelvis (clinical pelvimetry to assess adequacy of pelvis for labour):
---• Type of pelvis:
------• gynecoid
------• android
------• anthropoid
------• platypelloid
---• Pelvic inlet:
------• sub-pubic arch (should not be narrow)
------• prominence of sacrum (should not be too prominent)
------• symphysis-sacral distance
---• Midpelvis: prominence of spines (should not be too prominent)
---• Pelvic outlet: inter-tuberous distance
8. Extremities: check for edema and varicosities

Vital signs, Weight (calculate BMI)