ANTENATAL ASSESSMENT

Identification Data

Name: Date:

Age: Time:

Religion:

Education/Occupation:

Address:

Date of First Examination:

LMP:
EDD:

Obstetrical Score:

Chief Complaints:

Physical Examination

General Appearance :
Nourishment :
Body built :
Height :
Weight :
Vital signs : Temp
: Pulse
: Respiration
: B.P.

Head to foot examination :

Head:
Hair:
Scalp:
Face:
Facial puffiness:
Chloasma gravidarum:

7
 Eyes:
Eye brows :
Peri-orbital oedema:
Conjunctiva: Pallor
Sclera :
Pupils :
Vision :
Mouth:
Lips : dry, pale, cracked, angular stomatitis
Oral hygiene :
Dental caries :
Any inflammation:
Gum bleeding :
Tongue :
Ears:

Hearing:
Discharge:

Neck:

Range of motion:
Lymph node enlargement:

Chest:

Breath sounds : Vesicular sounds

: Wheezing

Heart : heart rate

: Cardiac murmurs

Axilla : any lymph node enlargement

Breast:
Inspection :

Palpation :

Abdomen
8
 Inspection :

Palpation:

- Fundal palpation: fundal height

Part of fetus present in fundus:
- Lateral Palpation:
Left side
Right side

- Pelvic palpation:
- First pelvic grip :
Engagement / not engaged
- Pawliks Grip: Fixed/ Mobile
Auscultation: FHR
Back:
Any abnormalities :
Back ache :

Extremities:

Range of motion :

Ankle oedema :
Capillary refill :
Genitalia:
Discharge :
Abnormalities : itching, irritation, swelling

Impression: