OBSTETRIC EXAMINATION | AIIMS Rishikesh, Lecture notes of Human Biology

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OBSTETRIC EXAMINATION

Dr Rakhi gaur

PRIOR TO EXAMINATION

• Need a warm and private environment.
• Check patients ID, consider the need for a Chaperone (Screen)
• Wash your hands (preferably ensuring they are warm)
• Introduce yourself and say what status you hold
• Explain why you need to palpate the patient’s abdomen
• Gain verbal consent
• Ensure the patient has emptied her bladder to avoid discomfort
• Position patient appropriately – supine - head and top of shoulders only

supported by pillow - hands by side. (Be aware of supine hypotensive

syndrome)

Palpation

• Maintain your patient’s dignity at all times
• Expose only as much of your patient as is required.
• Ensure that your patient is positioned appropriately and that you have warm hands.
• Palpate the abdomen using even movements of the flat of the palmar surface of closed fingers. (Aim to maintain hand to skin contact as much as possible rather than taking hands on and off the surface of the abdomen).
• Do not prod the abdomen or use jerky movements as these are likely to irritate the uterus and stimulate a contraction.

• Use even movements of the flat of the palmar surface of closed fingers.
• Aim to maintain hand to skin contact as much as possible.
• Do not prod the abdomen or use jerky movements as these are likely to irritate the uterus and stimulate a contraction.

The fundal height

• The woman lies supine.
• Palpate for the fundus first. The fundus is not usually palpated

abdominally before 12 weeks gestation.

• Apply gentle pressure with the flat palmar surface of your hand moving

downwards from the xiphisternum - to palpate the top of the fundus. The

fundal height can be measured in Cm.

• Place the zero end of the tape measure at the fundus.

Measurement of fundal height Zero of the tape measure is held at the fundus. Gently stretch the tape measure over the abdomen to the superior border of the symphysis pubis. Look on the reverse of the tape, and document the measurement in centimeters.

Palpation- identifying the PRESENTATION ▪ The uterus is gently palpated between the palms of two hands. ▪ The fetal part in the upper pole (in this case the breech) and the lower pole of the uterus are identified. ▪ Characteristically the breech is softer than the head, there is no angle formed by the neck and the surface continues smoothly with the back.

Position

• The position of the foetus is described by the relationship of the presenting part to the maternal pelvis
• The denominator for the presenting part for a Cephalic presentation = occiput and for a Breech presentation = sacrum

Assessing the fetal heart rate 2

• The fetal heart rate should be counted for a full minute

while also palpating the mother’s pulse (allows the

examiner to differentiate between maternal and fetal

heart rate).

• A normal fetal heart rate is between 110 – 160 beats per

minute (mother’s pulse should be counted separately).

PRESENTING and RECORDING Your findings

• 1.REPORT - observation / inspection
• 2. Fundal height in CMS = ……
• 3.The Lie is …..
• 4.The Presentation is ……
• 5.The Position is ……
• 6. Engagement?
• 7. Fetal Heart (FH) is ……
• 8. Other ???