Obstetric

Examination
- Ankit Suniyal


1. *Prior to examination
• Explain the procedure & Take informed consent
• Stand on Right side of the Patient
• Natural & adequate Lighting
• Privacy of the patient to be maintained- Screen
• Female attender, if examiner is a male– nurse/colleague
• Request the patient to undress herself, when needed

2. General Examination
• Comfortable at rest
• Conscious /comatose
• Oriented to time, place & Person
• Built (skeletal parameter) - moderate
• Nourishment (BMI)- poor/average *BMI calculation on pre pregnancy weight
• Weight =
• Height =
• Abdominal girth =
• Pallor , icterus , cyanosis , clubbing , pedal odema , lymphadenopathy

Vitals – BP , Pulse , RR , temp , SPO2

• Facial appearance
• Hirsutism
• Hydration status
• Periodontal diseases

OBS EXAMINATION | Ankit Suniyal

 • Signs of malnutrition (if anemia or low BMI)


Cardio-vascular System (CVS)

• Heart Rate & Rhythm-
• Heart sounds- S1 & S2
• Additional sounds – murmur, rub, gallop

Respiratory system (RS)
• Normal Breath sounds-
• Additional sounds
• Clear to percussion
• Tenderness to palpation

Breast Examination
• Symmetry
• Nipple retraction/crack
• Mass palpable

Thyroid
• Mass palpable
• Thyromegaly ?

Gait & Spine
• Malformation?? Of pelvis or spine
• Tenderness


3. Abdominal Examination

OBS EXAMINATION | Ankit Suniyal

 *Pre-requisite for Abdominal examination
Informed Consent
Cover the lower limbs with bedsheet
Screen/ privacy to be maintained
Female attender
Request the patient to undress the cloth over abdomen by herself
Ask her to void the bladder & Come

Inspection -
• Abdomen distention – uniform/irregular
• Flanks full or not
• All quadrants move equally with respiration?
• Umbilicus position (central, deviated to up / down),
• Umbilicus shape- inverted / flush to skin / everted
• Scars (LSCS scar ) - length , shape (longitudinal/transverse/curvi) , site , healed by
pri./sec./ter. intention
• Linea Nigra / striae gravidarm
• Visible pulsation, engorged veins
• Hernial orifices (inguinal /femoral) – free / full ?


Palpation
A) Fundal height
• gestation age in ____weeks with flanks full / not
• Patient’s leg in semi-flexed position (relaxed uterus)
• Correct dextro/levo rotation of uterus with right hand (dominant)
• And feel the resistance of uterine fundus with ulnar border of left hand
• Direction of the left hand (xiphoid to downward / below upward)

B) Symphysis Fundal Height

OBS EXAMINATION | Ankit Suniyal

 • Ask the permission to mark
• Legs to be extended now
• Measure with tape the distance in cm between pubic symphysis & Fundus
• Inch side of the tape should be toward yourself (to eliminate observer bias)
• Corresponds between 24-36 weeks, variations of +/-2 is accepted

C) Fundal grip / 1st Leopold grip
• Legs of patient in semi flexed position
• Palpate gently with fingers (not finger tips), apply firm pressure
• Move one hand at a time for palpation
• Move hands from lateral to midline

*head of baby= hard , globular with ballottable mass suggestive of head
*breech = firm , broad , irregular & non ballottable mass
*no parts palpable = transverse lie

D) Lateral grip / 2nd leopold grip / umbilical grip
• One hand for support (steady) & another hand for palpation
• Don’t poke finger tips
• Move one hand at a time
*Tone of uterus
*Amount of liquor
*back of the baby = smooth , curvilinear resistance felt
* Limbs = multiple knobby projections


Liquor content – reduced/adequate/increased

E) 1st Pelvic grip /Pawlik grip /3rd Leopold grip
First put the ulnar border of right hand on upper border of symphysis pubis

OBS EXAMINATION | Ankit Suniyal

 Palpate fetus head between thumbs & fingers
Look for head is ballottable or not
*in transverse lie pawlik grip is empty


F) 2nd pelvic grip / 4th Leopold grip
• Examiner’s face toward patient’s feet
• Palpate the lower abdomen from laterally to medially
• Check for whether the examiner’s hands are converging/diverging
• Level of sinciput & occiput of head


Scar tenderness (if prev. LSCS)
• Skin scar & uterine scar could be of different shape/size
* a sign of scar dehiscence/rupture


Auscultation (FHS)
• It Tells about whether fetus is alive/not
• FHS is best audible from the left scapular region of the baby(back of baby as close to
stethoscope/abdomen)
• Normal FHS = 110-160bpm
*In twin pregnancy, there should be 2 distinct FHS heard at least 10cm apart with the difference of
10bpm or more , by 2 observers
*Palpate the radial artery of the mother to distinguish it from the uterine artery Bruit & FHS


4) Estimated Fetal weight (Johnson’s formula)
• Fundal height (cm) – N * 155 = ______weight in gm
N = 12 , if vertex is above ischial spine (unengaged head)
N= 11, if vertex is below ischial spine (engaged head)

OBS EXAMINATION | Ankit Suniyal

*not applicable for multiple pregnancy

5) Diagnosis
• Age __obstetric index___ gest age__ with co-morbidities ___ diagnosed with _____
complications ____with single/two live fetus in cephalic/breech presentation with
adequate/inadequate liquor & not in labor, admitted for further evaluation / admitted for
safe confinement/delivery.



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OBS EXAMINATION | Ankit Suniyal