Physical examination

A. Vital signs are assessed.

B. Head. Funduscopy should seek hemorrhages or exudates, which may suggest diabetes or hypertension. Facial, hand and ankle edema suggest preeclampsia.

C. Chest. Auscultation of the lungs for wheezes and crackles may indicate asthma or heart failure.

D. Uterine Size. Until the middle of the third trimester, the distance in centimeters from the pubic symphysis to the uterine fundus should correlate with the gestational age in weeks. Toward term, the measurement becomes progressively less reliable because of engagement of the presenting part.

E. Estimation of fetal weight is completed by palpation of the gravid uterus.

F. Leopold's maneuvers are used to determine the position of the fetus.

1. The first maneuver determines which fetal pole occupies the uterine fundus. The breech moves with the fetal body. The vertex is rounder and harder, feels more globular than the breech, and can be moved separately from the fetal body.

2. Second maneuver. The lateral aspects of the uterus are palpated to determine on which side the fetal back or fetal extremities (the small parts) are located.

3. Third maneuver. The presenting part is moved from side to side. If movement is difficult, engagement of the presenting part has occurred.

4. Fourth maneuver. With the fetus presenting by vertex, the cephalic prominence may be palpable on the side of the fetal small parts.

G. Pelvic examination. The adequacy of the bony pelvis, the integrity of the fetal membranes, the degree of cervical dilatation and effacement, and the station of the presenting part should be determined.

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