Obstetric Examination Procedure Overview

Hello friends, Hi I am Dr. Sonali Chandra and I welcome you all to our YouTube channel Medicine Decoded. Now in this small video, I'm going to show you obstetric examination. Now before you examine a patient, make sure that you explain to the patient what you're going to do. All right, so take a verbal consent and at the same time you know make the patient lie down for examination after she passes urine right so ask her to empty the bladder because you see full bladder will interfere with your interpretation of the fundal height or the size of the uterus because if the bladder is full it pushes the uterus upwards then you might get a falsely high estimation of fundal height now make the patient feel comfortable be comfortable while she is being examined and also yes while you're positioning the patient keep in mind that you are going to examine the patient standing on the right side of the patient and the abdomen is exposed fully right from the pubic symphysis to the zutphi sternum this entire area and the rest of the area should be properly covered you know and patient is in the dorsal supine position like this right so the patient's head is on this side feet are on this side i'm standing to the right side of the patient okay and the hips and the knees are slightly flexed here and the knees are wide apart that allows for the relaxation of the abdominal muscle now also keep in mind that sometimes the uterus may be tilted towards one side or the other side okay so most of the times it is tilted towards the right side like this texture rotated so before you start palpating for the fundal height assessment make sure that you correct this tilt you correct the texture rotation and standing on the right side of the patient you can you know tilt the uterus like this stabilize it like this and then go on to estimate the fundal height so keep this in mind here one more important point before palpation centralize the uterus Now in this video, the patient that I am performing the obstetric examination on is a term patient. So let us begin. The patient is in dorsal supine position with knees and hips flexed and knees wide apart. So describing the inspection findings, this is the pubic symphysis and look at the ovoid bulge. Seems the fetus is longitudinally aligned. And you can see the umbilicus is central and inverted. And you can see these stria gravidarum, which are the stretch marks. And you can also see this deep line of pigmentation, you see, extending from the umbilicus to the pubic symphysis. And this is called as the linea nigra. And these are the stria gravidarum. And you can see that the overlying skin is healthy. There is no scar mark of any kind indicative of any previous surgery. Now for palpation, from symphysis pubis to umbilicus, we divide into two equal parts. If fundus is here midway between the umbilicus and pubic symphysis, fundal height is 16 weeks. If the fundus is at umbilicus, then the fundal height is 24 weeks. Now this is ziphy sternum. From ziphy sternum to umbilicus, we divide into three equal parts till here it is 28 weeks till here 32 weeks and all the way up to ziffy sternum it's 36 weeks now to see the fundal height we start palpating from the ziffy sternum using the ulnar border of our hand and see where we feel the fundus so this is 32 weeks but the patient is termed why so because the flanks are full bulk of the baby is in the flanks When the head goes down to the pelvis, flanks are occupied by the baby's body. So this is 32 weeks with flanks full. So this is a term size uterus. And now let us mark the fundal height by using a pen. So now to measure the symphysio fundal height in centimeters, we will have to ask the woman to straighten her legs first. So let's ask her to straighten the legs. And we take the inch tape here. Now the centimeter side should be away from our vision. And the inches side should be facing you. So this is the pubic symphysis pubis here and I place the inch tape here and then take it up to the mark which I had put right. So the inches is towards me and I turn it over this is 32. This is 32 centimeters. So 32 centimeters is our symphysio fundal height in centimeters and with flanks full okay. Let's see it again measuring the symphysio fundal height see. The centimeters side is away from your vision. This is 32 centimeters symphysophandal height with flanks full. So this is a term size uterus. Now we have to do the Leupold's maneuvers, the obstetric grips. For that, you have to ask the woman to flex her knees and hips again with the knees wide apart and that relaxes the abdominal muscles. Now the first three grips are done facing the patient. So checking the fundal grip now, I am palpating broad soft part like the buttocks and then for the lateral grips you stabilize with one hand on one side and then do the grip on the other side. Like I am here palpating the right side of the mother so this is the right lateral grip. You look more closely, here I am feeling knobby parts on the right side of the mother suggestive of fetal limbs and on the left side I am feeling a curved part which is suggestive of the fetal. Now for the third grip that is the polygrip, we use one hand. We use one hand to grasp the presenting part. Now if the head is free, it is belottable. But here the head is not free. Now for the fourth grip, which is the pelvic grip, right, we face the patient's legs, okay. And we take the two hands and try to dig here, you know, below the presenting part, we try to go beneath the presenting part with both our hands parallel. to the inguinal ligament as you can see okay but my two hands are not converging below the presenting part right that means that the head has gone deep into the pelvis okay that means that the head is most likely engaged now let us palpate the contractions okay now for that you have to place one hand on the woman's fundus here and then feel feel the uterus so like here the uterus is relaxed because i'm able to to indent the uterine wall with gentle pressure by my fingers here. But when the uterus is contracted and there's hardening of the uterus, this indentation of the wall of the uterus will not be possible. Okay. And the woman will complain of pain. So what did we see? Here are the buttocks, head is here, back is here on left side, limbs here on right side. So longitudinal lie, cephalic presentation back on the left side. So occiput is also on the left side. So this is left occipito position. It could be transverse or anterior. Left occipito transfer or left occipito anterior, we don't know as of right now. The confirmation of LOA or LOT or for that matter occipito posterior position will eventually be done by the PV examination. But the position of the fetal heart sound, where the fetal heart sound is heard with maximum intensity, will give us a very good idea about the position. In occipital anterior position, fetal heart rate is best heard anteriorly. In occipital posterior position, fetal heart rate is best heard at the flanks. Should I auscultate here? No. I will auscultate here because fetal heart sounds are best heard transmitted from the fetal backside. So in this case on the left side. So where exactly should we auscultate? Now this is the umbilicus and this is the anterior superior ilex spine now between these two points let us imagine a spinoambulical line and mid point here of this line here is where one should auscultate for the fetal heart sound so let me auscultate here now as the head goes down into the pelvis you see the fetal heart rate also moves towards the midline and downwards now i can hear it here best This means the head has gone down deep into the pelvis and it is LOA position, left occipital anterior. Now let us hear with Doppler and auscultate for pull 1 minute. And remember as the head goes down deep into the pelvis, the fetal heart rate moves more towards the center and downwards. So at the end of this examination, we can conclude that this is a term sized relaxed uterus with cephalic presentation in LOA position, left occipital anterior position.

So let us begin. The patient is in dorsal supine position with knees and hips flexed and knees wide apart. So describing the inspection findings, this is the pubic symphysis and look at the ovoid bulge. Seems the fetus is longitudinally aligned.

And you can see the umbilicus is central and inverted. And you can see these stria gravidarum, which are the stretch marks. And you can also see this deep line of pigmentation, you see, extending from the umbilicus to the pubic symphysis.

And this is called as the linea nigra. And these are the stria gravidarum. And you can see that the overlying skin is healthy. There is no scar mark of any kind indicative of any previous surgery.

Now for palpation, from symphysis pubis to umbilicus, we divide into two equal parts. If fundus is here midway between the umbilicus and pubic symphysis, fundal height is 16 weeks. If the fundus is at umbilicus, then the fundal height is 24 weeks. Now this is ziphy sternum.

From ziphy sternum to umbilicus, we divide into three equal parts till here it is 28 weeks till here 32 weeks and all the way up to ziffy sternum it's 36 weeks now to see the fundal height we start palpating from the ziffy sternum using the ulnar border of our hand and see where we feel the fundus so this is 32 weeks but the patient is termed why so because the flanks are full bulk of the baby is in the flanks When the head goes down to the pelvis, flanks are occupied by the baby's body. So this is 32 weeks with flanks full. So this is a term size uterus.

And now let us mark the fundal height by using a pen. So now to measure the symphysio fundal height in centimeters, we will have to ask the woman to straighten her legs first. So let's ask her to straighten the legs. And we take the inch tape here. Now the centimeter side should be away from our vision.

And the inches side should be facing you. So this is the pubic symphysis pubis here and I place the inch tape here and then take it up to the mark which I had put right. So the inches is towards me and I turn it over this is 32. This is 32 centimeters. So 32 centimeters is our symphysio fundal height in centimeters and with flanks full okay.

Let's see it again measuring the symphysio fundal height see. The centimeters side is away from your vision. This is 32 centimeters symphysophandal height with flanks full.

So this is a term size uterus. Now we have to do the Leupold's maneuvers, the obstetric grips. For that, you have to ask the woman to flex her knees and hips again with the knees wide apart and that relaxes the abdominal muscles. Now the first three grips are done facing the patient.

So checking the fundal grip now, I am palpating broad soft part like the buttocks and then for the lateral grips you stabilize with one hand on one side and then do the grip on the other side. Like I am here palpating the right side of the mother so this is the right lateral grip. You look more closely, here I am feeling knobby parts on the right side of the mother suggestive of fetal limbs and on the left side I am feeling a curved part which is suggestive of the fetal.

Now for the third grip that is the polygrip, we use one hand. We use one hand to grasp the presenting part. Now if the head is free, it is belottable.

But here the head is not free. Now for the fourth grip, which is the pelvic grip, right, we face the patient's legs, okay. And we take the two hands and try to dig here, you know, below the presenting part, we try to go beneath the presenting part with both our hands parallel.

to the inguinal ligament as you can see okay but my two hands are not converging below the presenting part right that means that the head has gone deep into the pelvis okay that means that the head is most likely engaged now let us palpate the contractions okay now for that you have to place one hand on the woman's fundus here and then feel feel the uterus so like here the uterus is relaxed because i'm able to to indent the uterine wall with gentle pressure by my fingers here. But when the uterus is contracted and there's hardening of the uterus, this indentation of the wall of the uterus will not be possible. Okay. And the woman will complain of pain. So what did we see?

Here are the buttocks, head is here, back is here on left side, limbs here on right side. So longitudinal lie, cephalic presentation back on the left side. So occiput is also on the left side. So this is left occipito position.

It could be transverse or anterior. Left occipito transfer or left occipito anterior, we don't know as of right now. The confirmation of LOA or LOT or for that matter occipito posterior position will eventually be done by the PV examination.

But the position of the fetal heart sound, where the fetal heart sound is heard with maximum intensity, will give us a very good idea about the position. In occipital anterior position, fetal heart rate is best heard anteriorly. In occipital posterior position, fetal heart rate is best heard at the flanks.

Should I auscultate here? No. I will auscultate here because fetal heart sounds are best heard transmitted from the fetal backside. So in this case on the left side. So where exactly should we auscultate?

Now this is the umbilicus and this is the anterior superior ilex spine now between these two points let us imagine a spinoambulical line and mid point here of this line here is where one should auscultate for the fetal heart sound so let me auscultate here now as the head goes down into the pelvis you see the fetal heart rate also moves towards the midline and downwards now i can hear it here best This means the head has gone down deep into the pelvis and it is LOA position, left occipital anterior. Now let us hear with Doppler and auscultate for pull 1 minute. And remember as the head goes down deep into the pelvis, the fetal heart rate moves more towards the center and downwards.

So at the end of this examination, we can conclude that this is a term sized relaxed uterus with cephalic presentation in LOA position, left occipital anterior position.

Transcript for:Obstetric Examination Procedure Overview

Transcript for:
Obstetric Examination Procedure Overview