Obstetric examination
General examination
- General appearance
- Weight
- Height
- Temperature
- Oedema – ankles/sacrum
- Anaemia
- Cardiovascular system
- Respiratory system
- Place women in semi recumbent position
Inspection
- Shape of uterus? Symmetrical?
- Fetal movements
- Scars – supra pubic (Caesarean section, laparotomy), sub umbilical (laparotomy), right iliac fossa (appendicectomy), right upper quadrant (cholycystectomy)
- Striae gravidarum?
- Linea nigra?
Palpation
- Symphysis-fundal height measurement (measure with cm marks down), fundal height roughly equates to number of gestational weeks
- Large SFH raises possibility of
- Macrosomia
- Multiple pregnancy
- Polyhydramnios
- Small SFH may be due to
-
IUGR
-
oligohydramnios
- Palpate to count fetal poles
- Assess lie (only necessary after 34-36 weeks)
- Establish presentation – cephalic, breech. Establish using Pawlik’s grip, grasp presenting part with index finger and thumb of presenting part
- Assess if presenting part is engaged or not, engaged if 2/5 or less if palpable
- Don’t try to assess fetal position as you can often be wrong and baby often changes in labour
Auscultation
- Pinard stethoscope positioned over fetal shoulder
- Hand held Doppler
- Fetal heart rate should be 110-160 beats per minute
Other aspects of examination
- In the presence of hypertension and headache consider fundoscopy
- Check reflexes in pre-eclampsia (presence of more than 3 beats of clonus is pathological)