Physical Examination

The equipment necessary for the examination of the pregnant woman is the same as for the nonpregnant woman. In addition, specialized instruments such as an ultrasonic Doppler scanner or fetoscope may be used to listen to the fetal heart. The ultrasonic scanner can detect the fetal heartbeat as early as gestational weeks 6 to 7;an ultrasonic Doppler scanner is used at about week 10;and a fetoscope or stethoscope can be used after the 20th week to auscultate the fetal heartbeat.

Always try to make the patient as comfortable as possible. She should be examined in comfortable surroundings, with attention to privacy. Discuss with her all the procedures that you will perform. The patient's gown should open in the front for ease of examination. The patient is draped in the same way as discussed in previous chapters and as shown in Figure 19-26. If the patient is in advanced pregnancy, avoid having her lie for a long period on her back, because the gravid uterus diminishes venous return and produces supine hypotension. It is useful for the woman to urinate before the pelvic examination. As always, wash your hands before beginning the examination. Make sure that your hands are warm and dry.

Because the examination of the pregnant woman is identical to the examinations described in the other chapters of this book, only special techniques and modifications for pregnancy are discussed here.

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