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Obstetric Examination

From Mediwikis

Performing an effective Obstetric examination is important for both clinical practice and in OSCE examinations. This guide to the Obstetric Abdominal Examination demonstrates effective technique, and a structured approach to monitor antenatal patients, and detect the clinical signs of pregnancy.

Introduction

  • Introduce yourself, wash your hands and explain what you are going to do
  • The patient should be at a 15°, exposed from just below the breasts to the bikini line.

Inspection

  • General inspection of patient:
    • Weight
    • Appearance ("Looks well")
  • Hands, looking for anaemia, commenting on temperature and feeling the pulse.
  • Look for skin changes on hands, face and abdomen (palmar erythema, striae gravidarum, linea nigra, pregnancy mask)
  • Abdomen:
    • Abdominal distension ("compatible with gestation?")
    • Visible fetal movements
    • Linea nigra
    • Striae gravidarum
    • Rashes
    • Look for scars

Palpation

Ask the patient if there is any pain or tenderness across their abdomen- the pubic symphisis is often tender during latter stages of pregnancy

  • Measure symphiseal fundal height
    • Recommended to measure from variable point (fundus) to fixed point (symphisis)
    • Standard deviation is 2 cm +/- up to 36wks, 3 cm +/- after 36wks
  • Fluid ("Liquor") volume

Fetal palpation

Leopold's maneuver, to determine Fetal lie

At this point it can be useful to "cheat" and ask the woman which way she thinks the fetus is lying, or which side she feels movements on (i.e. limbs are on)- but don't take this to be completely accurate!

  • Number of babies
  • Fetal lie – longitudinal, oblique or transverse
  • Which side does the back lie towards?
  • Comment on the presentation – breach or cephalic
  • Palpate fetal head to check for engagement, comment how many fifths of the head are palpable

Auscultate

  • Listen to the fetal heart rate at the baby’s anterior shoulder – look away from the patient and listen for a minute, avoiding touching the Pinard or abdomen
  • Measure maternal pulse to differentiate fetal heart sounds from mothers.

Completion

Handy Acronym

Remember FLIPPER BUS!

  1. Fundal – symphyseal height
  2. LIe of fetus
  3. Presenting Part of fetus
  4. Engagement of head
  5. Rate of fetal heart
  6. Blood pressure
  7. Urinalysis
  8. Swelling

Symphaseal Fundal Height

Causes of high SFH:

Causes of low SFH: