PHYSICAL EXAMINATION

FOR PREGNANT WOMAN

Francia Toledano RN MD
Clinical Instructor
 BASELINE HEIGHT, WEIGHT AND
VITAL SIGNS MEASUREMENT
• A woman’s weight and height are measured at a first prenatal visit to establish a pregnancy
BMI to serve as a baseline for future comparison. Record this assessment with her
prepregnancy BMI, if available, to determine how much weight she has already gained or
lost
BMI = wt (kg) / height (cm) 2

“A sudden increase in blood pressure and a sudden weight gain are both danger signs that
gestational hypertension may be occurring. A sudden increase in pulse or respirations could
suggest undetected bleeding.”
 DANGER SIGNS OF PREGNANCY
1. Vaginal bleeding
2. Persistent vomiting
3. Chills and fever
4. Sudden escape of fluid from the vagina
5. Swelling of face and fingers
6. Visual disturbance( blurring of vision, spots before the eyes)
7. Painful urination/ dysuria
8. Abdominal pain
9. Severe or continuous headache
 MEASUREMENT OF FUNDAL
HEIGHT AND FETAL HEART SOUND
• At about 12 to 14 weeks of pregnancy, the uterus
becomes palpable as a firm globular sphere
showing over the symphysis pubis.
• It grows to reach the umbilicus at 20 to 22 weeks
and the xiphoid process of the sternum at 36 weeks.
• In primiparas, it then often returns to about 4 cm
below the xiphoid process because of “lightening”
for the rest of pregnancy.
• If a woman is past 12 weeks of a pregnancy, assess
whether the fundus of the uterus is palpable,
measure the fundal height (from the top notch of
the symphysis pubis to the superior aspect of the
fundus)
 MEASUREMENT OF FUNDAL
HEIGHT AND FETAL HEART SOUND
• Auscultate for fetal heart sounds (a rate
of 110 to 160 beats/min is normal) by
Doppler if the pregnancy is past 10
weeks (the lower limit at which they can
usually be heard). Palpate for fetal
outline and position after the 28th week
as a further estimation of fetal size and
growth.
LEOPOLD’S MANEUVER
LEOPOLD’S MANEUVER
LEOPOLD’S MANEUVER
 LABORATORY ASSESSMENT
• URINALYSIS : Urine is tested for proteinuria (protein in urine), glycosuria (glucose in
urine), nitrites (bacteria in urine), and pyuria (white blood cells in urine suggesting an
infection).
• A serologic test for syphilis (venereal disease research laboratory [VDRL] or rapid plasma
reagin test). If syphilis is present, it must be treated early in pregnancy before fetal damage
occurs
• Serum antibody titers for rubella, hepatitis B (HBsAg), hepatitis C, varicella
(chickenpox) may be assessed. These tests determine whether a woman is protected against
these diseases if exposure should occur during pregnancy. Vaccines against these diseases
can then be offered in the postpartum period. HBsAg testing may be repeated at about 36
weeks.
 LABORATORY ASSESSMENT
• If a woman has a history of previously unexplained fetal loss, has a family history of
diabetes, has had babies who were large for gestational age (9 lb or more at term), has a BMI
over 30, or has glycosuria,

• she will need to be scheduled for a 50-g oral 1-hour glucose loading or tolerance test
(sometimes called a glucose challenge test) toward the end of the first trimester (12
weeks) to rule out gestational diabetes

• The addition of a serum (HgA1C) has the best predictive value for identifying diabetes
 LABORATORY ASSESSMENT
• If she is not high risk, she will have this test prescribed routinely at the 24th to 28th week of
pregnancy.

• A glucose challenge test analyzes how well a woman’s body is able to process sugar or
whether the insulin-antagonistic effects of placental hormones are counteracting pancreatic
insulin and causing an elevated blood glucose (a sign of gestational diabetes, which as many
as 2% to 5% of woman develop during pregnancy).

• Normally, a woman’s plasma glucose level should not exceed 130 to 140 mg/dl at 1 hour
after glucose ingestion
 LABORATORY ASSESSMENT
• Blood typing (including Rh factor). Blood type is documented because blood may have to
be made available if a woman has bleeding during pregnancy and to detect the possibility of
ABO and Rh isoimmunization.

• An indirect Coombs test (determination of whether Rh antibodies are present in an Rh-

negative woman). This test is generally repeated at 28 weeks of pregnancy. If an Rh-negative
woman’s titer is not elevated, she will be offered RhIG (RhoGAM) at 28 weeks of
pregnancy, after any procedure that might cause placental bleeding (amniocentesis or
external version), and within 72 hours after delivery.
 THE RH FACTOR: HOW IT
CAN AFFECT YOUR
PREGNANCY
• What is the Rh factor?
Just as there are different major blood groups, such as type A and type B, there also is
an Rh factor. The Rh factor is a protein that can be present on the surface of red blood
cells. Most people have the Rh factor—they are Rh positive. Others do not have the Rh
factor—they are Rh negative.

• How does a person get the Rh factor?

The Rh factor is inherited—passed down through parents’ genes to their children. If the
mother is Rh negative and the father is Rh positive, the fetus can inherit the Rh gene
from the father and could be either Rh positive or Rh negative. If the mother and father
are both Rh negative, the baby also will be Rh negative.
• Can the Rh factor cause problems during pregnancy?
The Rh factor can cause problems if you are Rh negative and your fetus is Rh
positive. This is called Rh incompatibility. These problems usually do not occur
in a first pregnancy, but they can occur in a later pregnancy.

• What happens if there is Rh incompatibility during pregnancy?

When an Rh-negative mother’s blood comes into contact with blood from her
Rh-positive fetus, it causes the Rh-negative mother to make antibodies against
the Rh factor. These antibodies attack the Rh factor as if it were a harmful
substance. A person with Rh-negative blood who makes Rh antibodies is called
"Rh sensitized."
• How does Rh sensitization affect the fetus during pregnancy?
Problems during pregnancy can occur when Rh antibodies from an Rh-sensitized
woman cross the placenta and attack the blood of an Rh-positive fetus. The Rh
antibodies destroy some of the fetal red blood cells. This causes hemolytic
anemia, where red blood cells are destroyed faster than the body can replace
them.

Red blood cells carry oxygen to all parts of the body. Without enough red blood
cells, the fetus will not get enough oxygen. Hemolytic anemia can lead to serious
illness. Severe hemolytic anemia may even be fatal to the fetus.
• Can Rh sensitization be prevented?

Yes. If you are Rh negative, you will be given a shot of Rh immunoglobulin
(RhIg). RhIg is made from donated blood. When given to a nonsensitized Rh-
negative person, it targets any Rh-positive cells in the bloodstream and prevents
the production of Rh antibodies. When given to an Rh-negative woman who has
not yet made antibodies against the Rh factor, RhIg can prevent fetal hemolytic
anemia in a later pregnancy.
 HIV IN PREGNANCY
• The CDC recommends that all women be tested in early pregnancy for HIV, and those at
high risk should be retested in the third trimester (CDC, 2016a).
• High-risk criteria include women who have used or are using intravenous drugs; have
engaged in sex with multiple partners; have had sexual partners who are infected or are at
risk because they are bisexual, intravenous drug users, or hemophiliac; or received a blood
transfusion between 1977 and 1985
• Screening for HIV is done by an enzyme-linked immunosorbent assay (ELISA) on a
blood sample. If this is positive, the finding is confirmed by a second test (a Western blot).
• Testing for HIV early in pregnancy allows a woman who is found to be HIV antibody
positive the opportunity to begin therapy with a combination of anti-retrovirals which can
decrease the risk of her infant acquiring the virus.