Obstetrics and Gynecology/Obstetric Examination

The Obstetric Examination involves the examination of the pregnant abdomen. This should always be performed after a thorough Obstetric History as this will guide the examination. The components of the examination are:

• General Approach
• Inspection
• Palpation
• Auscultation
• Conclusion of the Examination

General Approach

The obstetric examination requires a thoughtful physician as many pregnant women are very aware of the risks to themselves and the fetus during pregnancy. A great deal of sensitivity is required upon discovery of any abnormal finding.

Inspection

When inspecting the pregnant abdomen, adequate exposure is essential. The patient should be exposed from the xiphisternum to the top of the pubic hair line. The first item of note is the presence of a distended abdomen in keeping with pregnancy. The other findings on inspection include:

• Abdominal symmetry
• Movement with respiration
• Linea nigra
• Striae gravidarum (recent striae are purple; old striae are white)
• Surgical scars
• Fetal movements visible

Palpation

Palpation of the pregnant abdomen involves:

• Measurement of uterine size from the uppermost point of the fundus to the pubic symphysis

1. Palpate the upper margin of the fundus using the ulnar aspect of the dominant hand
2. Palpate the symphysis pubis using the index and middle fingers of the non-dominant hand
3. Measure the distance with the inches side of the tape facing upward to avoid examiner bias
4. From 20-36 weeks the abdomen should be 2cm either side of the gestation date
5. From 36-40, this increases to 3 cm
6. Note if the size matches the dates

• Assessment of fetal position

1. Place both hands either side of the ubilicus
2. Press deep with one hand in a medially oblique angle of 45 degrees to the umbilicus and hold
3. Press deep with the other hand and remove slowly, then repeat above and below the initial non-dominant palpation
4. Repeat the last two steps but with switched hand roles
5. Palpate the lower border of the uterus and find the presenting part of the fetus
6. Note the position, presentation and lie of the fetus
7. Note if the head is engaged

Auscultation

Auscultation of the fetal heart is done using a fetal stethoscope or a doppler. Auscultate for one minute and determine the fetal heart rate.The normal fetal heart rate usually varies between 120 and 160

References

• www.clinicalexam.com
• www.oup.co.uk
• Clinical Guidelines from the Government of Western Australia Department of Health