Various parameters and procedures can be used to monitor the condition of the pregnant woman and evaluate the growth, development, presentation and vital functions of the foetus.
The check-up examination in pregnancy includes the following aspects:
- General inspection.
- Blood pressure measurement.
- Determination of weight.
- External obstetric examination.
- Inspection.
- Palpation (determination of fundal height, presentation of the foetus and station of the presenting part).
- Auscultation of the foetal heartbeat.
- Laboratory tests.
General Inspection
Evaluate the data from the present situation and the general inspection from the examination performed early in the pregnancy.
Pay specific attention to:
- General nutritional status.
- Oedema (face, hands, ankles).
- Increase in or development of varicose veins.
To gain an impression of the degree of oedema, palpate the oedema by pressing the skin against a hard sublayer (e.g., the tibia) so that a dimple (pitting oedema) forms. Depending on the depth of the dimple, the oedema is referred to as: +, ++, or +++.
Blood Pressure
During pregnancy, the mother’s systolic blood pressure (measured on the brachial artery) remains virtually unchanged. The diastolic blood pressure often falls in the second trimester by 10-15 mmHg (mid-pregnancy dip) and rises once again in the third trimester to a pre-pregnancy level.
Both the blood pressure level and any changes between two check-ups are important. A systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg should generally be defined as hypertension. However, an increase in blood pressure at a subsequent check up of more than 30 mmHg systolic and/or 20 mmHg diastolic is also cause for alarm, even if the associated blood pressure remains below 140/90 mmHg. If increased blood pressure is measured, the measurement can be repeated after the patient has rested for 10 minutes.
Weight
During pregnancy, weight gradually increases by an average of 10 to 12 kg. The cause and physiological significance of this has been considered in “Changes in the Maternal Body“.
During the first trimester of pregnancy, this weight increase is mostly quite small (average 1.2 kg), and during the second trimester it is slightly more pronounced than in the third trimester.
Excessive weight gain in the second half of the pregnancy (500 g per week measured over three successive weeks) is indicative of interstitial fluid accumulation and precedes oedema and gestational hypertension. Manifest oedema is mainly found in the lower extremities, abdominal skin, hands, face and sacrum.
Very little or no increase in weight, and certainly a loss of weight, may be indicative of foetal growth retardation.