Booking Exam and Investigations - Obstetrics

Booking Exam and Investigations

·        Exam:

o  Pulse, blood pressure

o  Weight and height ® BMI

o  Signs of thyroid disease

o  Signs of anaemia

o  Heart and lungs (eg wheeze, mid systolic murmur common, pan systolic and diastolic abnormal)

o  Breast exam, including nipples

o  Abdominal (masses, large liver, etc)

o  Oedema

o  Varicose veins

o  Fundal height

o  Fetal Heart rate by monitor (if old enough)

o  Vaginal 

o  Bi-manual – uterus size consistent with dates and no adnexal masses. Uterus becomes an abdominal organ (rather than pelvic) at 12 weeks

·        Tests:

o  Blood:

§  FBC: check for anaemia 

§  Blood group: check if RH –ive. If so, mark clearly in notes. Give Anti-D following birth or invasive procedure

§  RBC Antibodies (eg Anti-D, Anti-ABO, etc)

o  Serology:

§  Syphilis (VDRL): treat with course of penicillin IM 

§  Hepatitis B: if +ive, test and immunise partner and close contacts. At birth give Hep B IgG and Hep B vaccine to baby (repeat at 1 and 6 months) 

§  Rubella: If negative for Rubella and pregnant then NO vaccine (it‟s a live vaccine). Stay away from kids. If she gets sick, repeat serology 2 – 3 weeks later to see if it was Rubella. 70% fetuses affected in 1^st trimester, drops to < 5% by 16 weeks. 

o  MSU for protein, bacteria and glucose 

o  High vaginal swab where indicated for chlamydia, gonorrhoea, bacterial vaginosis, candida, trichomoniasis, etc 

o  If indicated:

§  Smear if not up-to date

§  Ultrasound if dates unsure (otherwise offer morphology at 18 weeks)

§  Tb if high risk (immigrant, family contact, etc)

§  Sickle cell anaemia if black 

§  a-feta protein/triple test if at risk of Down

o   HIV test if at risk

o   If > 35 then offer amniocentesis

·        Subsequent visits: see Topic: Assessment of Fetal Growth and Well-Being