Obstetric physical examination - PowerPoint Presentation

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Obstetric physical examination

حمیرا شادکاماستاژر بیمارستان مهدیه

Essential definitions

The Presentation: is the part of the fetus in the lower part of the uterus overlying the pelvic brim( cephalic, breech )

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 biparietaldiameter 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, poly hydramnios

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 overted.Skin changes: look for stretch marks, linea

nigra, scars that indicates previous surgeries.

Palpation

: by leopold maneuverPalpate 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 size.

If cant move independent from the body: breech

If moves freely between fingertips: head

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

.

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 at the same part of the back and sincipital at the opposite side of the back)

If the sinciput higher the occiput: well flexed

If both prominences are at the same level: deflexed

If cant palpate the prominences, and the bulk of the head is felt at the same side of the back: extended

Auscultation

: help assess fetal well beingAuscult the whole abdomen trying to locate the point of maximum intensity

Don’t forget to perform a pelvic exams but important landmarks to notice during pelvic exam are:

Pubis symphasis

Ischial spine

After you examine a pregnant woman 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

.

2. Lie of the fetus

: only longitudinal lie is normal3. 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 contractions2. assessment of the cervix dilatation

1 finger: 1-2 cm dilated

2 fingers: 3-4 cm dilated

3 fingers: 5-6 cm dilated

4 fingers: 7-10 cm dilated

3.Effacement of the cervix

: thinning of the cervix(%) or length(cm). The cervix is normally 3-5 cm. if cervix is about 2 cm from external to internal os: 50% 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.

Thank You