Wednesday, May 23, 2012

Script for Short Case in Obstetrics

Before begining  :

#    Introduction
#    Permission
#    Positioning
#    Exposure
#    Comfortable
#    pull your measuring tape earlier (it would be annoying if u do it during palpation)

For abdominal Examination in Obstetric,

Inspection

1]  The abdomen is distended by gavid uterus.

2]  as evidences of linea nigra and striae gravidarum
      (also must note wether she have striae albicans , suggestive of previous pregnancy)

3]  There is no previous surgical scar noted.

 #( must be very carefull in finding the scar,especially the C-sect scar that could be hidden below the tummy                   skin fold )

*if there is previous surgical scar,describe the scar as :
       a) location of scar
       b) size(measure it with ruler) and shape of the scar
       c) any colour  changes
       d) well-heal or not (state wether any hypertrophic scar or keloid, primary or secondary intention)

4]  Abdomen is moving with respiration.
      (if patient in severe pain or having peritonitis,the abdomen might not moving with respiration)

5]  State to the examiner if there is any visible fetal movement or any dilatation of vein. (If absent, better to    not say it )

6]  The umbilicus is centrally located.
      (centrally located when the distance between xiphisternum and umblicus is equal to umbilicus to  symphisis pubis )##the examiner like to ask this, why u say it is centrally located..


Palpation

7]  Start with light palpation. The abdomen is soft and non-tender, there is no uterine irritability.

8]  Measure the clinical fundal height first. Here is some refference...
      at xiphisternum = 36 week or 40 week (40w if the flank is full and u cannot get below the costal rib)
      1 finger breath below xiphisternum = 34 w or 38 w (38 if flank is full and can`t get below the rib)
      at umbillicus = 22 weeks
     1 finger above umbilicus = 24 weeks
   
     #the technics is by take the point from 1 finger above umbilicus(24 week) and to the xiphisternum(36
       week)..the idea is by dividing the 2 point with 3 partition and each partition signifies 4 weeks)

9]   Measure the SymphisioFundal Height (SFH) with ur measuring tapes. Use inch first,then look in cm to avoid bias. Measure from xiphisternum till the symphisis pubis(the heightest point of symphisis pubic bone)

     # be honest and professional.


Then,do fundal grip,lateral grip and pelvic grip

10]   Singleton fetus

11]   Longitudinal lie

12]   Cephalic presentation

13]   Fetal back is at Rt/Lt side of mother

14]   Head engagement

      #head is consider engage when it is at 2/5 or less. If  3/5 and above,we state,it is not engaged,3/5
        palpable

       #head is round,hard,firm and ballotable.

       # practice and practice, to be able differentiate between breech and cephalic
   
      # in twin, there will be more than 2 pole palpable

15]   Liquor is clinically adequate / excess / inadequate

16]   Estimated fetal weight .


I think, thats all I wanna share today. Enjoy ur OnG posting !!



BE A GREAT DOCTORS =)


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