Obstetric Examination

Question 1

What are the components of the obs exam?

Answer 1

1. intro
2. general inspection
3. abdominal inspection
4. abdominal palpation
   4.1. SFH
   4.2. Lie
   4.3. Presentation
   4.4. Engagement
5. Auscultate
6. Thank you

Question 2

Obs Exam 1. Intro:

Answer 2

• Wash hands* Hi my name is Jennifer and I’m one of the medical students here today. Could I confirm your name and age? I’ve been asked to examine you which would involve looking at your belly, feeling for the baby and listening to the baby’s heart beat. Does that sound ok with you? Are you in any pain? Ok, please let me know if you are at any point. I’ve got a chaperone here who will be present for the exam.

Question 3

2. Obs exam general inspection

Answer 3

X appears comfortable, colour is normal, no signs of oedema. would be in a semi recumberent position, adequately exposed fro the pubic symphysis to the xiphoid. Her abdomen is distended in line with gestation.

Question 4

3. Obs exam closer inspection - abdomen

Answer 4

On closer inspection of the abdomen there are no visible scars, striae gravidarum, linea nigra, tattoos or piercings. The umbilicus is inverted.

Question 5

4. Obs exam - palpation?

Answer 5

1. Fundal pal/ SFH: “I’m going to begin by feeling for the top of your womb.” so with my left hand I am starting at the xiphoid and working down till I reach the fundus. Tape measure facing downwards. Pinch tape measure at pubic symphysis and turn over to obtain measurement.
   SFH in cm = weeks of gestation +/- 2cm
2. Lie: “I’m now going to feel for your baby”
   (longitudinal lie or transverse)
   Comment on Liquor Volume
3. Presenting part: “I’m going to feel deeply for the baby. If this is painful please tell me.” (hard, narrow, round = head; soft, broad = bottom)
   (cephalic or breech
4. Engagement of the head: how many fingers are needed to over the head over the pelvic brim?
   Portion of fetal head palpable
5. Pinnard over anterior shoulder of fetus

Question 6

Clinical signs of small fundal height?

Answer 6

fetal descent into pelvis before delivery
intrauterine growth restriction
oligohydramnios

Question 7

causes of large fundal height?

Answer 7

macrosomia
multiple pregnancy
polyhydramnios

Question 8

What are the causes of maternal growth restriction?

Answer 8

Maternal causes:
- increasing maternal age
- smoking
- alcohol
- infections (CMV, toxo, rubella, symphilis)
- diabetes
- renal disease
- hypertension
- thrombophylia
- drugs e.g. warfarin, phenytoin, steroids

Placental causes: pre-eclampsia, abruption

Fetal causes: chromosomal abnormalities, anencephaly, multiple pregnancy

Question 9

What are the risk factors for breech presentation?

Answer 9

high maternal parity as lax uterus, uterine anomaly, placenta previa, pelvic bony abnormality, smoking, diabetes, fetal malformations, multiple pregnancy, poly or oligohydramnios, low birth weight, previous breech delivery

Question 10

What are the physiological changes in pregnancy? cardio

Answer 10

Cardiovascular
! Cardiac output increases 30–50% (both heart rate and stroke volume increase)
! Reduced systemic vascular resistance due to progesterone and response to placental invasion
(may cause postural hypotension)
! BP falls during mid-pregnancy and returns to normal by week 36
! Impaired venous return from the IVC due to pressure from the gravid uterus in late
pregnancy
! RAAS activation, salt & water retention, peripheral oedema

Question 11

Resp changes in preg

Answer 11

! Increased tidal volume
! Compensated respiratory alkalosis (lower maternal PaCO2 facilitates placental gas transfer)

Question 12

Other changes in preg

Answer 12

1 Gastrointestinal
! Increased appetite
! Lower oesophageal sphincter relaxation due to progesterone (predisposes to reflux) ! Reduced GI tract motility & increased transit time (constipation common)
! Gallbladder dilatation & incomplete emptying (predisposes to gallstone formation)
1 Urinary
! Increased renal blood flow & GFR
! Ureteric & bladder relaxation due to progesterone (increases risk of UTI)
1 Endocrine
! Increasing progesterone & oestrogen
! Suppressed FSH & LH
! Increased ACTH and cortisol
! Increased prolactin
! Increased T4 & T3 but also increased thyroxine-binding globulin
! Reduced peripheral insulin sensitivity (predisposes to gestational diabetes)
1 Haematological
! Increased plasma volume & dilutional anaemia
! Slightly raised white cell count
! Reduced serum iron, increased transferrin & TIBC
! Increased clotting factors (VII, VIII, IX, X) & reduced fibrinolytic activity (≠ VTE risk)
1 Skin
! Hyperpigmentation of umbilicus, nipples, abdominal midline (linea nigra) & face (chloasma) ! Striae gravidarum
! Palmar erythema (hyperdynamic circulation)
1 Musculoskeletal
! Increased ligament laxity (causes back pain & pubic symphysis dysfunction) ! Exaggerated lumbar lordosis in late pregnancy
NOTES