Question

Antenatal Scenario

Sara Mohammed a 37- year old female pregnant came to hospital for follow up during 35 weeks gestation age.

She is G2p1A0.
Her LMP: 11/7/2019.

She had complaints of back pain , incontinence and constipation .

Past Obstetrical History:

-1 previous NSVD (Normal spontaneous vaginal delivery
-Last birth was 3 years ago by NSVD, weighed 3200 grams
-No previous obstetrical complications or morbidity

-No Past Medical Surgical History or Family history

Social History:

Patient lives with her husband in Riyadh . Denies any smoking, alcohol or other drug use during her pregnancy. Currently works as a housewife. Good economic status.

Physical exam :

Vital Signs: Stable (BP – 120/70, P – 72)
General Appearance: No apparent distress, appeared clinically stable
Uterine Height: 35cm
Fetal Lie: Longitudinal

Presentation: Cephalic

Position: Right

Contractions: Present
Fetal Heart Tones: 144 / minute

Questions:

1- What is the physical examination and tests should be done to evaluate the patient's ?

2-Sara is suffering from constipation. What is the best education you will give to Sara about relief measures?

NOTE:

please write the answer by keyboard, so that the answer will be clear....thanks.

Answer 1

Physical examination

It is the first steps of screening of a patient in hospital setting done by the physician or by the nurse.

It is done by mainly four methods.

1.Observation. 2.Palpation 3. Percussion 4. Auscultation.

So when sara come to the hospital for her antenatal visit these physical examination methods will used by the physician or nurse.

Firstly when sara come to hospital for antenatal visit we should check her weight.

As in the questions main baseline examination finding of gravid mother i.e. sara shown like uterine height, lie, presentation, fetal heart sound, contractions, position.

We should check the dilaton of the cervix of sara to assess the status of dilaton of cervix.

Apart from these finding physician may prescibe Random blood sugar to check the blood glucose level of the patient,

urine for protein to asses any protein urea,

urine for sugar to asses gestational diabetes,

complete hemogram to check the hemoglobin level of patient and to assess any anaemic condition.

We can also check her for any sexually transmitted infection like Chlamydia, gonorrhea, syphilis because these can also infect the baby during normal vaginal delivery.

Sara can be assess for group B streptococcus screening because this infection is not cause any problem to her but can be very fatal for her unborn child.

2. To relief from constipation therse following measure can be taken-

1.Sara should eat high fibre diet that incude legumes, fruits like orange, apple, raspberry, banana,dried figs, strawberry etc, in vegetables like broccoli, carrot, potato etc.

2. Sara should drink lots of water to relieve constipation.

3. She can do some physical activity like walking.

4. She should avoid refined foods.

5. She should take small and frequent meal instead of taking 3 large meal.

6.she can use probiotics like yogurt, curd that stimulate the intestinal bacteria to breakdown food better to keep thigs moving.

7. She should use kegel exercise to strengthen the pelivic floor musle.

Sara can use all these measure to relieve constipation if all these are not helping then physician should prescribe some laxative agent to her to relieve her symptoms.