Obstetric Examination

Question 1

Introduction

Answer 1

Wash hands, PPE
Introduction - Hello, I’m An Nakamura a 3rd year medical student.
Patient ID, DOB - Can I confirm your name and DOB
Explanation - I’ve been asked to examine your tummy. I’ll look, feel, take some measurements. This may be uncomfortable at times but should not be painful. If you’d like me to stop then please let me know. I’ll reposition the couch so the head is at 45degs.
Questions - Do you have any questions? Are you happy for me to start my examination
Are you in any pain?

Question 2

General inspection

• surroundings
• patient

Answer 2

Surroundings

• mobility aids
• vital signs
• fluid charts
• prescriptions

Patient

• discomfort/pain
• obvious scars
• pallor - anemia?
• jaundice?
• edema - arms, legs, face - preeclampsia???

Question 3

Inspection of abdomen

-what are you looking for

Answer 3

Gravid uterus
Abdo symmetry
Movement with resps
Linea nigra
Stretch marks
Surgical scars
Fetal movements

Question 4

Palpation

• how would you do this
• what are you assessing for

Answer 4

Uterine size - uppermost fundus - pubic symphysis

Leopold’s maneuvres
1st - top of uterus - which end of fetus is in the fundus
-head/breech - vertical lie
-body - transverse lie
2nd - sides of abdo - location of fetal spines and limbs
-spine - firm, smooth
-extremities - irregular, may mv
3rd - above pubic symphysis - fetal engagement
-head felt and mobile - not engaged
-head not felt - fully engaged

Question 5

Auscultation

Answer 5

1min of fetal heart rate

Question 6

Urinalysis and BP

-what are you looking for

Answer 6

Protein, leukocytes, glucose

• preeclampsia
• UTI
• GD

BP - high - PET?