1. Preparing for OB Clinicals: Assessing DTRs and Clonus in Preeclamptic Patients

2. Assessing Patellar Reflexes
Position the woman with her legs hanging over the edge of the bed
Briskly strike the patellar tendon, which is located just below the patella
Normal response is extension or a thrusting forward of the foot

3. Patellar Reflex

4. Lying Down Position
If the patient is too critical to sit up at the edge of the bed
Raise her leg off the bed by putting your hand under the knee
Strike the tendon
Assess the reflex

5. Assessing Bicep Reflexes
Flex the woman’s arm 45 degrees at the elbow and place your thumb on her biceps tendon
Fingers hold the biceps muscle
Strike your own thumb in a slightly downward motion and assess the response
Normal response is slight flexion of the arm
Only use bicep reflex if unable to assess the patella reflex; patella reflex easier to assess

6. Bicep Reflex

7. Documenting Reflexes
Reflexes (but not clonus) are graded on a scale of 0 to 4+ as follows:
4+ Hyperactive; very brisk, jerky, or
clonic response; abnormal
3+ Brisker than average
2+ Average response; normal
1+ Diminished response; low normal
No response; no movement

8. Assessing Clonus Patient placed in supine position
With the woman’s knee flexed and the leg supported, vigorously dorsiflex the foot
Maintain the dorsiflexion momentarily, then release
With a normal response, the foot returns to its normal position of plantar flexion
Assess for clonus by counting the foot “jerks” or beats

9. Assessing Clonus

10. Documenting Clonus There should be no beats of clonus
Depending on severity of CNS over-stimulation, patient can have anywhere from 1-4 beats of clonus
More beats there are, the more over-stimulated the CNS and therefore the greater risk of having a seizure