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Assessment of a woman (2.Clinical examination (a.General appearance (pale,…
Assessment of a woman
History
a. General
medical
surgical
allergies
medication
c.RH & RDV Status
b. Obstetric
2.Clinical examination
a.General appearance
pale
jaundiced
cyanotic
mobilising well
distressed
b. BIG 5
CNS
= central nervous system: Glasgow Coma Scale, reflexes, orientated
CVS
=cardiovascular system:BP&pulse, normal core auscultation
Respiratory System:
respiratory rate, saturation, auscultation of lung fields
Hepatic system / gastro-intestinal system:
organomegaly (hepato/spleno megaly), jaundice, normal bowel sounds, abdominal distension, pain (on palpation, rebound, guarding, localised or generalised)
Renal system:
urinary output, dipstick of the urine, colour of the urine, presence of renal angle tenderness
c. Forgotten 4
Haemotological:
bleeding tendencies (petechiae, puncture sites keep bleeding), bedside bleeding/clotting test (sideward coagulation tests), biochemistry (haemoglobin, platelets, clotting tests)
Immunological:
temperature, signs of infection? RVD status. Biochemistry (white cell count, C-reactive protein, procalcitonin), cultures taken (wound site, blood cultures, sputum, urine, amniotic fluid,…)
Endocrine system
Breast examination
Thyroid examination
Glucose metabolism
Musculoskeletal
Signs of Deep Vein Thrombosis
Edema?
Reflexes
d. Core Examination
Core 1=abdominal palpitation
Symphysis-fundal height/uterine size (before AND after delivery)
Abnormalities palpated (e.g. fibroids)
Previous abdominal surgery?
Fetal lie
Descent of presenting fetal part as fifths above brim
Contractions palpated?
Fetal heartrate
Core 2=vaginal examination
Appearance of external genitalia
Appearance of vagina & cervix (if speculum examination indicated)
Cervix: dilatation, effacement, “feel” (irregular: suspicion of benign warts, signs of intervention in case of unsafe termination of pregnancy, suspicion of cervical malignancy)
Membranes intact / assessment of liquor (clear, meconium, bloodstained)
Fetal presenting part
Descent of presenting part
Risk assessment of patient
a. Difficult surgery anticipated
Obesity
Previous abdominal/uterine surgery
Placental abnormalities
b. Haemorrhage anticipated?
iRisk factors for PPH => 2nd stage CD, previous CD, previous PPH, placental abnormalities, multiple gestation, macrosomia, prolonged labour, polyhydramnios,…
Patient’s haemoglobin and clotting normal?
Crossmatch done?
Blood products available?
c. Infection anticipated?
Diabetes
Obesity
Chorioamnionitis, prolonged rupture of membranes, MSL,…
d. Premedication
Aspiration prophylaxis
Infection prophylaxis
Rhesus prophylaxis required post-delivery?
Counselling and consent / future contraception?
a. Intra-operative bilateral tubal ligation?
Intra-operative IUD insertion?
Organ systems called Big 5 because they KILL