Obstetric examination

Question 1

Obs exam - Introduction

Answer 1

• Wash hands
• Introduce
• Check patient identity
• Explain procedure
• Gain consent
• Offer chaperone
• “Do you need to empty your bladder before I examine you?”
• Position (45°) and expose patient

Question 2

Obs exam - General inspection

Answer 2

• Comfortable at rest? Breathless?
• Signs of anaemia
  
  • Conjunctival pallor
• Chloasma
  
  • Hyperpigmentation of face (physiological)
• (Palpate) Hyperdynamic circulation

Question 3

Obs exam - Inspection

Answer 3

• Abdominal distension
  
  • Size
  • Symmetry
• Surgical scars
  
  • Caesarean (suprapubic)
  • Laparotomy (? placenta praevia)
  • Laparoscopy
• Striae
  
  • Gravidarum (pink = new)
  • Albicans (white = old)
• Linea nigra

Question 4

Obs exam - Palpation

Answer 4

• Symphysis-fundal height
  
  • Distance (cm) should correlate with gestational age (+/- 2cm)
  • Fundus approaches xiphisternum ~36 weeks
• Palpate abdomen
  
  • Ballot with flat hands laterally/diagonally to assess the lie
    
    • Longitudinal
    • Transverse
    • Oblique
  • Walk hands (transverse) to assess position (baby’s back relative to the mother)
  • Pawlik’s grip to assess presentation (warn may be uncomfortable)
    
    • Head ballotable (unless engaged)
  • Assess engagement
    
    • Two hands pointing towards the mother’s feet
    • Ask mother to breathe in to aid palpation
    • Engagement ≤ 2/5 palpable

Question 5

Obs exam - Auscultation

Answer 5

• Place Pinnard’s stethoscope on anterior shoulder of foetus
• Remove hands, check mother’s pulse
• Normal range of foetal heart rate 110-160
• If using Doppler, remember to use gel and offer a tissue afterwards