Obstetrics examination
1. Introduce yourself – Ask patient name, permission to examine
2. Expose patient – Comment on why only exposing the abdomen
3. Start at foot of the bed – INSPECTION
A. General:
- Eg. Young, gravid female
- Distress?
- Adequate nutrition?
B. Abdomen:
- Globally distended abdomen? (consistent with gravid uterus?)
- Scars? - ***Make sure to look specifically for a Pfannenstiel! May have to lift belly! It is not always obvious!!
- Notable linea nigra?
- Notable striae gravidarum? (New striae = hyperpigmented. Old = hypopigmented)
- Umbilicus – inverted, flat, everted?
- Movement with respiration?
- Hair distribution?
- Fetal movements seen?
C. Legs:
- Ask patient about pain before touching
- Pedal oedema?
4. ABDOMEN PALPATION [Leopold’s maneuvers]
FIRST MUST: ASK IF ANY PAIN! Can palpate abdomen for – Soft, tense, tender? THEN Leopold’s maneuvers
A. Do #1 [Fundal grip] – then feel for the part/pole at the fundus [Describe: Head = “round, firm”. Breech = “Irregular, soft”]
- Measure symphysiofundal height [**Start tape measure FROM sup. bord. of PS to fundus – ie. Say “measuring
from the fixed point to the mobile point”]
Measure SFH on inches side but report in cm [Say reason: “to eliminate bias”]
Ask patient to put finger to mark the point of fundus while you measure
B. Do #2 [Lateral/Umbilical grip] – Ensure to feel for:
- Number of fetuses
- Fetal back [Described as: Smooth, convex, regular]
- Fetal limbs [Described as: Irregular, concave?]
- Lie of fetus
- AUSCULTATE fetal heart
C. Mention “I will bypass Pawlik’s grip [#3]” [Must still demonstrate how you would do it AND SAY the 2 reasons: 1. Painful 2. Gives no additional information that Leopold’s (other) maneuvers will not provide]
D. Do #4 [Pelvic grip] – and ballot presenting part - “Feel for fifths”
- Then +/- fluid thrill for polyhydramnios
Remainder of examination:
5. Hands – pallor
- Pulse
- ASK for BP
6. Face: Eyes – mucous membranes and Icterus
- Mouth – mucous membranes!
7. ASK for urinalysis results AND weight!!
8. Thank patient and cover
9. Comment on findings
Summary example:
“In summary, I found a gravid female:
1. Symphysiofundal height of ...
2. Singleton pregnancy
3. Longitudinal lie
4. Cephalic presentation
5. Fetal back on the maternal right, limbs on the
left
6. Appreciated fetal heart in the left iliac fossa,
with a rate of 136 bpm
7. Head was not engaged”
8. May also estimate amniotic fluid volume
2. Expose patient – Comment on why only exposing the abdomen
3. Start at foot of the bed – INSPECTION
A. General:
- Eg. Young, gravid female
- Distress?
- Adequate nutrition?
B. Abdomen:
- Globally distended abdomen? (consistent with gravid uterus?)
- Scars? - ***Make sure to look specifically for a Pfannenstiel! May have to lift belly! It is not always obvious!!
- Notable linea nigra?
- Notable striae gravidarum? (New striae = hyperpigmented. Old = hypopigmented)
- Umbilicus – inverted, flat, everted?
- Movement with respiration?
- Hair distribution?
- Fetal movements seen?
C. Legs:
- Ask patient about pain before touching
- Pedal oedema?
4. ABDOMEN PALPATION [Leopold’s maneuvers]
FIRST MUST: ASK IF ANY PAIN! Can palpate abdomen for – Soft, tense, tender? THEN Leopold’s maneuvers
A. Do #1 [Fundal grip] – then feel for the part/pole at the fundus [Describe: Head = “round, firm”. Breech = “Irregular, soft”]
- Measure symphysiofundal height [**Start tape measure FROM sup. bord. of PS to fundus – ie. Say “measuring
from the fixed point to the mobile point”]
Measure SFH on inches side but report in cm [Say reason: “to eliminate bias”]
Ask patient to put finger to mark the point of fundus while you measure
B. Do #2 [Lateral/Umbilical grip] – Ensure to feel for:
- Number of fetuses
- Fetal back [Described as: Smooth, convex, regular]
- Fetal limbs [Described as: Irregular, concave?]
- Lie of fetus
- AUSCULTATE fetal heart
C. Mention “I will bypass Pawlik’s grip [#3]” [Must still demonstrate how you would do it AND SAY the 2 reasons: 1. Painful 2. Gives no additional information that Leopold’s (other) maneuvers will not provide]
D. Do #4 [Pelvic grip] – and ballot presenting part - “Feel for fifths”
- Then +/- fluid thrill for polyhydramnios
Remainder of examination:
5. Hands – pallor
- Pulse
- ASK for BP
6. Face: Eyes – mucous membranes and Icterus
- Mouth – mucous membranes!
7. ASK for urinalysis results AND weight!!
8. Thank patient and cover
9. Comment on findings
Summary example:
“In summary, I found a gravid female:
1. Symphysiofundal height of ...
2. Singleton pregnancy
3. Longitudinal lie
4. Cephalic presentation
5. Fetal back on the maternal right, limbs on the
left
6. Appreciated fetal heart in the left iliac fossa,
with a rate of 136 bpm
7. Head was not engaged”
8. May also estimate amniotic fluid volume
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