Related Experiment Video
Updated: Jul 26, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
A Rational and Standardized Prenatal Examination
Ellery Sarosi1, Luke A Gatta2, Deborah R Berman3
1Medical Student, University of Michigan Medical School, Ann Arbor, MI.
Insights
Reviewing essential prenatal physical exams is crucial as care evolves post-COVID-19. Key maneuvers like fundal height and pelvic exams remain vital for screening asymptomatic patients.
Area of Science:
- Obstetrics and Gynecology
- Evidence-Based Medicine
- Telemedicine Integration
Background:
- Prenatal care is adapting post-COVID-19, necessitating a review of standard physical examination practices.
- The rise of telemedicine challenges traditional in-person prenatal visit structures.
- Ensuring comprehensive screening requires evaluating the efficacy of established examination techniques.
Approach:
- A comprehensive literature review was conducted, synthesizing research, reviews, textbook chapters, databases, and clinical guidelines.
- The review focused on the screening utility of physical examination maneuvers for various anatomical areas.
- The goal was to propose an evidence-based approach to the prenatal physical examination.
Key Points:
- An evidence-based prenatal exam for asymptomatic individuals includes checking the thyroid and lymph nodes, listening to the heart, measuring fundal height, and performing pelvic exams.
- Pelvic examinations are essential for gonorrhea/chlamydia testing, assessing pelvimetry, and monitoring cervical changes.
- Specific maneuvers retain significant screening value despite changes in healthcare delivery.
Conclusions:
- Certain physical examination maneuvers remain critical for screening asymptomatic prenatal patients.
- The findings support informed decision-making regarding the prenatal physical examination in the context of increased virtual care.
- An evidence-based approach ensures continued effective screening despite evolving healthcare models.
Importance:
As prenatal care is in transition after the COVID-19 pandemic, reviewing fundamental physical examination approaches is necessary for providers examining obstetrical patients.
Objective:
The objective of this review is 3-fold: (1) convey why the age of telemedicine necessitates reconsideration of the standardized physical examination in routine prenatal care; (2) identify the screening efficacy of examination maneuvers used within a standard prenatal examination of the neck, heart, lungs, abdomen, breasts, skin, lower extremities, pelvis, and fetal growth; and (3) propose an evidence-based prenatal physical examination.
Evidence Acquisition:
A comprehensive literature review identified relevant research, review articles, textbook chapters, databases, and societal guidelines.
Results:
We conclude that an evidence-based prenatal examination for asymptomatic patients includes the following maneuvers: inspection and palpation for thyromegaly and cervical lymphadenopathy, cardiac auscultation, fundal height measurement, and a pelvic examination for purposes including testing for gonorrhea and chlamydia, assessing pelvimetry, and assessing cervical dilation later in the pregnancy, intrapartum, or in the setting of ultrasonogram-detected prelabor preterm cervical shortening.
Conclusions And Relevance:
Although not true of all physical examination maneuvers, this article demonstrates that there are maneuvers that continue to play important screening roles in asymptomatic patients. With the increase in virtual visits and fewer in-person prenatal appointments, the rational basis for maneuvers recommended in this review should inform decision making around the prenatal examination performed.
