A Guide to Obstetric Exam

1. Introduction: Greet patient, ask patient’s full name, give your full name, your position
and explain what you are about to do.
2. Privacy and Respect: Ensure privacy, ask for a chaperone etc.
3. Preparation: Wash hands, ask patient to empty their bladder, collect tape measure and
Pinard stethoscope, expose adequately and position correctly etc. Explain aorto-caval
compression.
4. General Exam 1 (From the right foot end of the bed and from the bed side): Comment
on respiratory distress, build, nutritional status, abdominal movement with respiration,
abdominal distension, shape of abdomen, size of abdomen, Linea Nigra, Striae
Gavidarum, Chloasma, Spider angioma, everted umbilicus, surgical scars, fetal
movements etc. Note: Kneel while examining from the bed side and before touching
patient ask for any pain. Make mention of raised diaphragm.
5. General Exam 2: Do vitals, check for palmar erythema, oedema of fingers, spider
angioma, chloasma, facial oedema, conjunctival pallor, scleral jaundice, dental caries,
gingival enlargement, oral thrush, signs of nasal congestion, areolar pigmentation,
Montgomery tubercles, breast fullness, nipple inversion or cracks, skins rashes, Oedema
(pedal, ankle and pretibial), position of apex beat etc. Make mention of checking for
thyroid enlargement and importance of 4th korotkoff sound.
6. Obstetric Abdominal Exam: Palpate for uterine contractions, HoF and SFH. 20-22 weeks
at umbilicus. Correct using Mac Donald Rule. Use ulnar border of the hand and prevent
bias by hiding the cm. Feel for Presentation while facing away from the patient. Glances
are allowed. Mention Engagement. Do Fundal Palpation followed by lateral palpation.
Comment on the Lie, the fetal poles, fetal movements, fetal back and liquor volume.
Auscultate for fetal heart beat by using the Pinard stethoscope on the anterior shoulder.
Face away from the patient and feel mother’s radial pulse simultaneously. Normal fetal
heart rate according to WHO is 100 – 180 Bpm.
7. Concluding: Cover the patient, ask her to lie on her side before getting up and record
the results.
Note: The above is a very basic guide to some of the important points to consider during a
general obstetric exam. More details with regards to individual systems will be covered during
the course of the year as each system is covered in detailed.

Prepared By Academic Assistants 2018/19