Examining the Obstetrical Patient

=Objectives=

Describe how to calculate the EDC (Estimated Date of Confinement)

 * First day of last normal menstrual period + 280 days (40 weeks); Naegele’s rule: (LMP + 7 days) – 3 months
 * For example, a LMP of 3/23/2008 would predict a 1/1/2009 birth (EDC).

Recite other key milestones and measurements

 * Date of positive fetal heart tones with a Doppler instrument: 12-20 weeks
 * Date of maternal perception of fetal movement- occurs at 16-18 weeks in normal pregnancy
 * 1st trimester Ultrasound findings: correct within 1 week, conceptus can be seen 5-6 weeks after LMP ( hCG = 1500-2500mIU/ml)
 * Fundal height measurement: indicates age between 20 and 36 weeks

Know your G's and P's

 * Gravid - the number of times a woman's been pregnant
 * Parity, or births
 * Divided into 4 parts TPAL = term, preterm, abortions, living children
 * ex: G3P1112 could indicate a woman has been pregnant 3 times, had 1 term birth, 1 preterm birth (or miscarriage), 1 abortion, and has 2 living children.
 * tricky ex: G2P1002 could indicate a woman has been pregnant twice (and is currently pregnant), has given birth once to twins at term, and has 2 living children.

Explain the use or determination of uterine size, fetal heart tones, and leopold's maneuver

 * Uterine size:
 * Uterus at 8 weeks = size of orange
 * Uterus at 12 weeks = size of grapefruit
 * 20-36 wks fundal height (measured from pubic bone to top of uterus) = gestational age (30 weeks, 30cm)


 * Fetal heart tones/Doppler exam
 * heart tones heard by 12-20 weeks with doppler
 * heard by 18-20 weeks with fetoscope
 * normal fetal heart rate = 120-160 bpm


 * Leopold’s maneuver:
 * used to determine fetal lie (longitudinal, oblique, transverse)
 * presentation: part of baby closest to birth canal (cephalic, breech, shoulder, etc.)

=Links & References=