Antenatal assessment is the systematic evaluation of a pregnant woman and her developing fetus to promote a healthy pregnancy outcome. Midwives conduct these routine checks at every antenatal visit to establish baseline health, track physiological adaptations, and catch potential complications early. Every assessment combines a detailed history with physical examinations, creating a complete picture of maternal and fetal well-being in the Nigerian healthcare context.
Creating a safe, respectful environment begins long before touching the patient. Explain every procedure clearly in a language the woman understands, seeking her informed consent at each step. Ensure privacy by using screens and maintaining a warm, welcoming tone to reduce anxiety. Ask the woman to empty her bladder before the examination, as a full bladder causes discomfort, distorts abdominal findings, and displaces the uterus.
A comprehensive antenatal physical examination looks beyond the abdomen to evaluate overall maternal health.
Position the woman comfortably lying flat on her back, known as the supine position, with a small pillow under her head. Place a small wedge or folded towel under her right hip to tilt her slightly to the left. This simple adjustment shifts the heavy uterus off the inferior vena cava and aorta, preventing supine hypotensive syndrome—a sudden drop in maternal blood pressure that causes dizziness and reduces blood flow to the fetus. Expose only the abdomen from the xiphisternum to the pubic symphysis, draping the rest of her body to preserve her dignity.
Inspection involves careful visual observation of the maternal abdomen before touching it. Look at the shape and size of the uterus, noting whether it matches the expected period of gestation. Observe the skin for striae gravidarum (stretch marks), the linea nigra (dark midline pigmentation), and surgical scars from previous operations like a cesarean section. Watch for active fetal movements visible through the abdominal wall, which offer reassuring visual signs of fetal life in later pregnancy.
Abdominal palpation uses the warm palms of both hands to assess fetal growth and position. Midwives use Leopold's Maneuvers, a standardized sequence of four distinct steps performed after 24 weeks gestation:
Auscultation confirms fetal viability and well-being by listening to the fetal heart rate. You can use a Pinard stethoscope or an electronic Doppler device. Place the instrument over the area where you palpated the fetal back during Leopold's maneuvers. Count the beats for a full minute while simultaneously feeling the mother's pulse to ensure you are not confusing maternal and fetal heart rates. A normal baseline fetal heart rate ranges between 110 and 160 beats per minute.
Accurate documentation completes every physical and abdominal examination. Record your findings clearly in the mother's antenatal card, noting fundal height in centimeters, fetal lie, presentation, engagement, and heart rate. Compare current measurements with previous visits to track steady fetal growth. If you notice any abnormal findings—such as transverse lie, reduced fetal movements, or high blood pressure—take prompt clinical action, counsel the mother, and refer her to a medical officer when necessary.