3.5 IMPORTANCE OF GENERAL EXAMINATION

Weight: When it is taken at the initial visit (which should be early) it forms a baseline for compares during the subsequent visits. In the first 20 weeks a gain of 2.5kg is normal, then 0.5kg a weak in the 2nd 20weeks. A gain of about 12-12.5kg can be accounted for physiologically during pregnancy. Static, poor, or excessive gain should be a course of concern. Obesity is associated with an increased risk of gestational diabetes and PIH.

Blood Pressure: It is usually low in pregnancy. At every visit you compare the reading with the initial. An initial BP of > 140/90 mmHg should be considered high. An increase of 30mmHg in the systolic or 15mmHg in the diastolic is considered high blood pressure even when the value does not reach 140/90mmHg. A rise in Blood pressure during the 2nd half of pregnancy is indicative of pre-eclampsia. 

Pallor: It is indicative of anaemia. It can be detected through the conjunctiva, the palms of hand, sole of foot, tongue etc.

Oedema: A degree of oedema is normal but when it is excessive it may be associated with PIH and action should be taken. It may not be present at booking but occurs later in pregnancy.

Respiratory Rate: Should be assessed to rule out any underlying condition of the heart or lungs.

Breast Examination: To assess their suitability for breast feeding. The size and shape of the nipples is noted. Examine and feel for the presence of abnormal lumps.

Abdominal Examination: It is perform to determine fetal wellbeing. It is unlikely that the uterus will be palpable abdominally before the age of 12 weeks of gestation.

The uterus is expected to grow at a predicted rate and in early pregnancy the size will usually equate the gestational estimate by date.Later in pregnancy the increasing uterine size may be due to continuous fetal growth but it is less reliable as an indicator of gestational age. Factors like multiple pregnancy increases the overall uterine size and should be diagnosed by around the 24thweeks.

In a single pregnancy the fundus is palpable just above the symphysis pubis.

At 16 weeks the uterus is 7.5cm above the symphisis pubis or half way between the symphisis and the umbilicus. Quickening might be felt by the mother.

At – 22-24 weeks the fundus has reached the umbilicus 

At – 30 weeks the fundus is midway between the umbilicus and the xiphisternum.

At – 36 weeks the fundus has reaches its highest level and is in contact with the xiphisternum.

At the last month of pregnancy lightening occurs and the fetus sinks down into the lower pole of the uterus. The uterus becomes broader and the fundus lower. In the primigravida strong abdominal muscles encourage the fetal head to enter the brim of the pelvis.

Multiple Pregnancies: It is associated with increased risk of obstetric complications. Twin pregnancy is the commonest form of multiple pregnancies and Nigeria has the highest reported rate in the world (45/1000 birth) predisposing factors are ethnicity, family history of twins and assisted delivery.

Laboratory Investigation: It is important for early detection of abnormalities.

1.  Full blood count, PCV or HB estimation is done to determine the level of haemoglobin which carries oxygen for circulation. It also helps in assessing the adequacy of the iron stored.

 2. Blood grouping is important to determine the ABO group and Rhesus factor, in case of any emergency transfusion.

 3. Venereal Disease Research Laboratory (VDRL) is done to detect syphilis for prompt management to avoid fetal infection/abnormality.

4. HIV testing should be done after counseling to reduce the chances of mother-to-child transmission through intervention.

5.Urinanalysis is carried out to exclude abnormality like bacilluria, protein due to contamination by vaginal discharge, or disease like UTI or PIH, glucose caused by higher level in blood, or as a result of disease, Ketones due to increased maternal metabolism caused by fetal need or due to vomiting.