Obstetric Examination

Introduction

• Presenter: Dr. Shanali Chandra
• Channel: Medicine Decoded
• Topic: Obstetric Examination
• Steps: Explained verbally with demonstration on a term patient

Pre-Examination Preparations

• Explanation to Patient: Describe the procedure to the patient and obtain verbal consent.
• Patient Positioning:
  • Ask the patient to empty the bladder to avoid interference with fundal height estimation.
  • Patient lies in a dorsal supine position with hips and knees slightly flexed and knees apart.
  • Examiner stands on the right side of the patient.
  • Ensure the abdomen is fully exposed from pubic symphysis to xiphisternum while the rest of the body is covered.
• Uterus Positioning: Centralize the uterus by correcting any tilt (usually tilted towards the right side).

Inspection

• Position of Uterus: Indicates longitudinal arrangement of the fetus.
• Physical Signs:
  • Umbilicus is central and everted.
  • Presence of striae gravidarum (stretch marks).
  • Presence of linea nigra (deep pigmentation line from umbilicus to pubic symphysis).
  • No scar marks indicating previous surgeries.

Fundal Height Measurement

• Divisions and Corresponding Measurements:
  • From symphysis pubis to umbilicus: Divide into two parts, midway indicates 16 weeks, at umbilicus 24 weeks.
  • From xiphisternum to umbilicus: Divide into three parts: 28 weeks, 32 weeks, 36 weeks.
  • Patient in demonstration has a fundal height of 32 weeks but is at term due to full flanks.

Symphysio-fundal Height Measurement

• Process:
  • Ensure patient's legs are straightened while measuring.
  • Measure from the pubic symphysis to the marked fundal height using centimeter side away from vision and inch side facing.
  • Demonstrated measurement: 32 cm indicating term size uterus with full flanks.

Leopold's Maneuvers / Obstetric Grips

• Preparation: Patient flexes knees and hips for relaxation of abdominal muscles.
• Grips:
  • Fundal Grip: Feel broad, soft part (buttocks).
  • Lateral Grips: Stabilize one side, feel opposite. Right side (limbs), Left side (curved part, back).
  • Pelvic Grip: Grasp presenting part, check if head is free or engaged.
  • Fourth Grip: Face patient's legs, check engagement depth of head in pelvis.

Assessing Uterine Contractions

• Process: Palpate fundus to check if uterus is relaxed (indented with gentle pressure) or contracted (hardened, no indentation possible).
• Findings: Relaxed uterus at the initial stage.

Fetal Position and Heart Sound Auscultation

• Position Determination:
  • Buttocks at fundus, head presenting, back on left, limbs on right indicating cephalic presentation.
  • Determine left occipito-anterior (LOA) or transverse (LOT) position.
• Heart Sound:
  • Best heard on the left. Auscultation point: Between umbilicus and anterior superior iliac spine.
  • Auscultate for a full minute using Doppler.
  • Heart sound location shifts towards midline and downwards as head engages in pelvis.

Conclusion

• Summary: Term-sized relaxed uterus, cephalic presentation in LOA (left occipito-anterior) position.