Transcript Obstetric physical examination

Obstetric physical examination
In the initial presentation,
full physical examination
should be done.
Abdominal & pelvic
examination remains
important exam for pregnant
women because it is the
easiest method of fetal
monitoring.
Essential definitions that you should know to
understand the physical examination
findings:
• The presentation:
is the part of the
fetus in the lower
pole of the uterus
overlying the pelvic
brim (cephalic,
breech)
• The lie of the fetus: is the relation of the
long axis of the fetus to the uterus (could
be longitudinal, oblique or transverse. only
longitudinal lie is normal)
• The attitude: is the posture of the fetus
(flexion, deflexion, extension)
• The position: of
the baby in relation
to the presenting
part of the mother’s
pelvis. It is
expressed
according to the
denominator which
is :
• occiput in vertex
presentation
• sacrum in breech
presentation
• mentum in face
presentation
Station & engagement
Station: is the relation
of the presenting part
to the ischial spine. If
the presenting part is
at the level of ischial
spine, station =0
Engagement: the
descent of the
biparietal diameter
through pelvic brim. If
the head is at the
level of ischial spine
the head must be
engaged.
Method of abdominal exam
• Inspection:
– Size of the uterus: assess
• If the length & breadth are both increased  multiple
pregnancies, polyhydramnios
• If the length is increased only  large baby
– Shape of the uterus: length should be larger than broad this
indicates longitudinal lie. But if the uterus is low and broad
indicates transverse fetus lie.
– Fetal movement
– Contour of the abdomen: full bladder may be visible in
late pregnancy. Umbilicus may become everted
– Skin changes: look for stretch marks, linea nigra, scars that
indicates previous surgeries
Method of abdominal exam
• Palpation: by Leopold maneuver-4 maneuvers
– Palpate the fundus (to determine if it contains breech,
head)
• By gentle pressure:
– if soft consistency/ indefinite outline  breech
– If hard, smooth, well defined  head
• Move your fingertips over the fetal mass to determine mobility
and sixe
– If can’t move independent from the body  breech
– If moves freely between fingertips  head
Method of abdominal exam
• Lateral palpation: (determine the position of the
fetal back and small parts)
• Hands are placed on each side of the umbilicus.
The fetal spine will palpate as firm, flat and
linear. The fetal extremities are palpable by their
varying contour and movements. The purpose of
this maneuver is to determine whether the fetal
back is left or right.
Method of abdominal exam
• Pelvic palpation: 2 maneuvers
• Grasp the lower poles of the uterus between fingers
and thumbs and comment of the size, flexion and
mobility of the head.
• To determine the position of the vertex presentation: try
to palpate the prominences (occiput @ the same side
of the back & sincipital @ the opposite side of the
back)
– If the sinciput is higher the occiput  well flexed
– If both prominances are at the same level  deflexed
– If can’t palpate the prominances, and the bulk of the head is
felt at the same side of the back  extended
occiput
siniciput)
Method of abdominal exam
• Auscultation: help assess
fetal well being
Auscult the whole abdomen
trying to locate the point of
maximum intensity
• Don’t forget to perform a
pelvic exam (details of pelvic
exam will be discussed in gynecological
exam) but important landmarks
to notice during pelvic exam
are
– Pubis symphasis
– Ischial spine
After you examine a pregnant women
you should answer the following
questions
1. What is the fundal
height?
It is estimated by
centimeters from
upper border of the
fundus to the pubis
symphasis by taping
measure. The
height of the fundus
correlates well with
the gestational age
especially during the
weeks of
pregnancy.
After you examine a pregnant women
you should answer the following
questions
2. lie of the fetus: only longitudinal lie is normal
3. Attitude: normally it is full flexion and every fetal
joint is flexed.
4. presentation: normally cephalic
5. position: according to the dominator
6. Is the vertex engaged?
Examination during labor
1. Palpate uterine contractions
2. Assessment of the cervix dilatation
•
•
•
•
1 finger  1-2 cm dilated
2 fingers  3-4 cms dilated
3 fingers  5-6 cms dilated
4 fingers  7-10 cms dilates
3. Effacement of the cervix: thinning of the
cervix (%) or length (cm). The cervix is
normally 3-5 cms. If cervix is about 2 cm
from external to internal os  50% effaced
50% effaced
100% effaced
4. Consistency of the cervix: soft vs. hard.
During labor the cervix becomes soft.
5. Position of the cervix: posterior vs.
anterior. During labor the cervix changes
from posterior to anterior.
6. Membrane is intact or ruptured:
assessed by fluid collection in the vagina