PHYSICAL

ASSESSMENT OF
NORMAL
PREGNANT CLIENT
JOCELYN C. TEBRERO, MAN, RN, MAN
ANN GRETHEL TAN, MAN RN
COLLEGE OF NURSING
OUR LADY OF FATIMA UNIVERSITY
Why do we need to
perform physical
assessment?
 General approach
 Make sure to always provide comfort and sense
of privacy
 Have the needed equipment readily at hand
 Provide gown and drapes for abdominal
examination
 Instruct the client to empty her bladder prior to
examination
 POSITION

 Semi sitting
position with the
knees bent
 Supine position
with pillow under
the legs
 EQUIPMENT

 The examiners hand are the

2
 HEAD AND NECK
 Hair: note for texture, moisture, and distribution, dryness, oiliness
 Eyes: anemia of pregnancy may cause pallor
 Nose: nasal congestion is common among pregnant women and nose
bleeds
 Mouth: inspect for gums and teeth, gingival enlargement with
bleeding is common
 Thyroid: symmetrical enlargement may be expected
 Skin pigmentation changes: Chloasma/melasma gravidarum –
irregular brownish patches of varying size appear on the face and
neck, “mask of pregnancy”
 Spider telanggieactasia – a vascular stellate marks resulting from
high level of estrogen. Typically develop in face, neck, upper chest
and arm
THORAX AND LUNGS
 Inspect thorax for the pattern of breathing

HEART
 Palpate for the apical impulse. Sometimes it may be slightly higher
than normal due to higher diaphragm
 Auscultate the heart; soft blowing are common, reflecting the
increased blood flow in normal vessels

BREAST
 Inspect breast and nipple for symmetry and color, nipple and areola become
bigger and darker
 Compress nipples with finger and thumb, may express colostrum
 ABDOMEN
 Inspect for skin changes: presence of Linea Nigra – darkening of the
linea alba
 Inspect for Striae gravidarum “stretch mark” due to stretching of
the abdomen, reddish or purplish in color and becomes silvery after
delivery
 Associated risk factors are weight gain during pregnancy, younger
maternal age, and family history
 Palpate for the fetal movement “quickening”
 Braxton hick’s contraction – abnormal painless contraction
 Auscultation of fetal heart tone 120-160bpm/110-160bpm
 Can be detected through stethoscope by 18 weeks AOG
 Can be detected through fetal Doppler at 10 – 12 weeks AOG
ABDOMEN
 Palpation:
 Mc Donald’s rule: used
to determine the age of
gestation
 Length of the fundus in
cm x 8/7 = AOG in weeks
 Length of the fundus in
cm x 2/7 = AOG in months
ABDOMEN
 Bartholomew’s Rule – to
determine the age of gestation
by fundic location
 3 months – just above the
symphysis pubis
 4 months – midway between
symphysis pubis and umbilicus
 5 months – at the level of the
umbilicus
 ABDOMEN
 Haase’s Rule – to determine
the length of the fetus in
centimeter
 Fisrt half of pregnancy (1 – 5
months) --- months ²
 Second half of the pregnancy
( 5 – 10 months) month x 5
LEOPOLD’S MANEUVER
 Are a common and systematic
way to determine the position of a
fetus inside the woman's uterus
 Named after the gynecologist
Christian Gerhard Leopold.
 Also used to estimate term fetal
weight.
 LM 1 ( FUNDAL GRIP)
 Palpation of the fundus to
determine which fetal part
occupies the fundus
 Fetal head should be round
and hard
 Buttocks soft and round
LM 2 (UMBILICAL GRIP)
 To determine which side
is the fetal back, usually
feels like a hard,
resistant, convex
structure
 Fetal extremities feels
nodular and irregular
LM 3 (PAWLIK’S GRIP)
 Suprapubic palpation using
thumb and fingers just
above the symphysis pubis
to determine fetal
presentation
 To know if it is cephalic or
breech presentation
 To know if the presenting
part is engage or still
floating “ballotment”
LM 4 (PELVIC GRIP)
 Palpation of the
bilateral lower
quadrants to
determine fetal
attitude
FETAL ATTITUDE
EXTREMETIES
 Inspect hands and legs for edema
 Palpate for pretibial, ankle and
pedal edema
 Physiologic edema is more common
in women who stands a lot
 Pathologic edema is often grade 3+
and often associated with PIH
 Check for leg varicosities
 GENITALIA
 Inspect for the hair distribution and color
 Scar from previous episiotomy or perineal laceration
 Inspect the anal area for varicosities (hemorrhoids)
 Inspect for vaginal discharge
 Inspect for warts, foreign body and smell
 Chadwick’s sign – bluish to purplish color of the cervix
due to increased vascularity
 Hegar’s sign – softening of the uterine isthmus and can be
observed by 6th to 8th week AOG
 Goodell’s sign – cyanosis and softening of the cervix, may
occur as early as 4 weeks AOG
CONCLUDING THE VISIT
 Once the examination is completed
instruct the client to get dressed
 Review findings
 Answer client’s questions
 Advise necessary laboratory procedures
that are needed
 Reinforce the importance of regular check
up
 Record findings in the chart of the client
 Compute for EDC using Naegel’s rule
1) LMP April 12, 2020 Technique in doing the physical assessment
2) LMP July 5, 2020 12)
3) December 31, 2019 13)
4) November 29, 2019 14)
5-8 LM 1-4 15)
5)
6)
7)
8)
9) Abnormal contractions felt by the mother and can be relieve by resting and walking
10) Mask of pregnancy
11) 1st movement felt by the mother on the 5-6thmonth of pregnancy