ADMISSION ASSESSMENT

•	History.
•	Physical examination.

History

1.	Antenatal:

a.	Ascertain gestational age of fetus. 

b.	Antenatal progress:

i.	complaints and complications.

ii.	investigations done and treatment received.

c.	Fetal status: growth and abnormalities detected.

2.	Obstetric:

a.	Previous births and birth weights.

b.	Miscarriages, abortions and stillbirths.

c.	Previous LSCS.

3.	Enquiry should be made about:

a.	Fetal movements.

b.	Abnormal vaginal discharge or bleeding.

c.	Whether the membranes are ruptured and if so, the color and amount of amniotic fluid lost. 

4.	Past medical and surgical history. 

Physical Examination

1.	General:

a.	State of patient.

b.	Vital signs: temperature, pulse and blood pressure.

c.	Input / output chart.

d.	Urinalysis. 

2.	Abdomen:

a.	Inspection for scars.

b.	Symphysis-fundal height measurements.

c.	Determine position of fetus and presenting part. 

d.	Degree of engagement.

e.	Liquor volume.

f.	Estimated fetal weight.

3.	Vaginal:

a.	Dilatation: when no cervix is felt, it means that it is fully dilated (10cm) and the presenting part can descend for delivery.

b.	Effacement:

i.	this is the shortening of cervical length.

ii.	at about 3cm of dilatation, the cervix should be fully effaced and then thinning.

c.	Position: 

i.	in a normal labor, the vertex will be presenting and the position can be determined by locating the occiput. 

ii.	the occiput is identified by feeling for the triangular posterior fontanelle with three sutures running into it.

d.	Station:

i.	- 1 or - 2: head is not engaged.

ii.	0 + 1: outlook is favorable for vaginal delivery.

e.	Condition of membranes:

i.	rupture: note color and amount of fluid draining.

ii.	copious amount of clear fluid: good prognostic factor. 

iii.	appearance of meconium-stained fluid may herald fetal distress and is an indication for electronic fetal monitoring.