Obstetric Examination Guide

Introduction

• Presented by Dr. Sonali Chandra on Medicine Decoded YouTube channel.
• The lecture focuses on performing an obstetric examination.

Pre-Examination Preparation

• Explain the procedure to the patient and obtain verbal consent.
• Ensure the patient empties her bladder to avoid interference with fundal height measurement.
• Position the patient in the dorsal supine position.
  • Head and feet aligned, examiner stands on the right side.
  • Abdomen exposed from the pubic symphysis to the xiphisternum.
  • Hips and knees slightly flexed, knees wide apart to relax abdominal muscles.

Examination Positioning

• Uterus may tilt; correct any dextrorotation before assessing fundal height.
• Centralize the uterus before palpation.

Inspection Findings

• Check for ovoid bulge indicating fetal alignment.
• Observe the umbilicus (central and inverted) and the presence of striae gravidarum (stretch marks).
• Identify linea nigra from umbilicus to pubic symphysis.
• Ensure skin is healthy with no surgical scars.

Palpation and Fundal Height Assessment

• Divide the distance from symphysis pubis to umbilicus into two parts.
  • Midpoint corresponds to 16 weeks.
  • At umbilicus is 24 weeks.
• Divide from xiphisternum to umbilicus into three parts.
  • Corresponds to 28, 32, and 36 weeks respectively.
• Palpate fundus starting from xiphisternum using ulnar border.
• For term patients, assess flank fullness to account for baby position.

Measuring Symphysiofundal Height

• Straighten patient's legs for accurate measurement.
• Use a measuring tape, keeping centimeters side away from view.
• Measure from pubic symphysis to fundal height mark.

Leopold's Maneuvers

• First Grip: Assess fundal grip for fetal position.
• Second Grip: Lateral grip to determine fetal body parts.
  • Right side for limbs, left side for fetal back.
• Third Grip: Polygrip for presenting part.
  • Check if head is belottable.
• Fourth Grip: Pelvic grip to assess fetal engagement.
  • Hands paralleled to inguinal ligament.

Uterine Contractions

• Feel for uterine relaxation or contraction by indenting the uterine wall.

Fetal Heart Sound Auscultation

• Occiput positioning determines best location for fetal heart sound.
• Left Occiput: Best heard on the left side between umbilicus and anterior superior iliac spine.

Conclusion

• Findings suggest a term-sized uterus with cephalic presentation in the left occipital anterior (LOA) position.
• As the head descends, auscultation points shift towards the midline and downwards.

These notes summarize the procedure and key considerations for conducting an obstetric examination as demonstrated by Dr. Sonali Chandra.