Assessment of a woman (2.Clinical examination (a.General appearance…
Assessment of a woman
c.RH & RDV Status
b. BIG 5
= central nervous system: Glasgow Coma Scale, reflexes, orientated
=cardiovascular system:BP&pulse, normal core auscultation
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)
urinary output, dipstick of the urine, colour of the urine, presence of renal angle tenderness
c. Forgotten 4
bleeding tendencies (petechiae, puncture sites keep bleeding), bedside bleeding/clotting test (sideward coagulation tests), biochemistry (haemoglobin, platelets, clotting tests)
temperature, signs of infection? RVD status. Biochemistry (white cell count, C-reactive protein, procalcitonin), cultures taken (wound site, blood cultures, sputum, urine, amniotic fluid,…)
Signs of Deep Vein Thrombosis
d. Core Examination
Core 1=abdominal palpitation
Symphysis-fundal height/uterine size (before AND after delivery)
Abnormalities palpated (e.g. fibroids)
Previous abdominal surgery?
Descent of presenting fetal part as fifths above brim
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
Previous abdominal/uterine surgery
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?
Blood products available?
c. Infection anticipated?
Chorioamnionitis, prolonged rupture of membranes, MSL,…
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