Obstetrics Examination

OVERVIEW
1. General inspection from end of bed
a. Expose maternal abdomen from symphysis publis to xiphoid
2. Vital Signs (temp, BP, pulse)
3. Cardiovascular
4. Respiratory
5. Neurological (If relevant to history)
6. Abdominal
a. Palpation for lie and presentation, SFH measurement
7. Pelvic

GENERAL INSPECTION
1. Expose maternal abdomen from symphysis pubis to xiphoid

2. Inspect the maternal abdomen for:

a. Striae gravidarum (stretch marks)
b. Linea nigra (midline hyperpigmentation)
c. Scars (appendicectomy, previous caesarean section)
d. Tattoos, piercings
e. Abdominal swelling or distended abdomen consistent with pregnancy

3. General appearance:
a. Comfortable
b. Well/ unwell
c. Pale/ flushed/ jaundiced
d. Oedematous

VITAL SIGNS
1. BP, pulse, temperature
a. Taken from the right arm with the patient lying in a semi recumbent position at an
approximately 30 degree angle

2. Observation chart at the end of bed

a. Temperature, BP pattern, daily urinalysis

3. Urinalysis
a. Proteinuria: diagnosis of pre-eclampsia, renal disease
b. Haematuria: underlying renal disease, renal colic, UTI
c. Glycosuria: diabetes, prompt GTT
d. Leucocytosis, Nitrates: diagnosis of UTI

CARDIOVASCULAR EXAM: heart sounds, murmurs

1. Physiological ‘Flow Murmur:’ very common in pregnancy
2. Lower Limbs: oedema
3. Bilateral Pitting Oedema: very common in 3rd trimester
4. Unilateral Pain & Swelling: DVT

RESPIRATORY EXAM
1. Percussion
2. Auscultation

NEUROLOGICAL EXAM
1. Examine reflexes and clonus in patients with Pre-eclampsia
2. Fundi
ABDOMINAL PALPATION
• Examined in the recumbent position, left lateral (to avoid compression of IVC)
• Abdominal palpation allows a subjective assessment of fetal size and amniotic fluid volume
 1. Fundus
a. Uppermost part of the uterus
b. Palpate down from level of xiphoid with ulnar border of your left hand until you reach
fundus of the uterus
c. At umbilicus at 20 weeks
• Fundal height @ 36 weeks gestation would be expected to measure: 34-38cm

2. Symphyseal fundal height (SFH)

a. Using a tape-measure from upper border of symphysis pubis to fundus
b. Record measurements in cm
c. SFH in cm = weeks of gestation +/- 2cm

3. Lateral Palpation
a. Determines the lie of the fetus  lie = position of fetus with respect to the longitudinal axis
of uterus
b. Lie must be either
i. Longitudinal
ii. Transverse/ Oblique
c. Place both hands flat on either side of the maternal abdomen
d. Fetus is gently ballotted between hands to determine the fetal lie and presentation

4. Presenting Part
a. Use hands to palpate lower pole of uterus and determine what part of fetus lies there
b. With a longitudinal lie, presenting part is either cephalic (vertex, head) or breech (bottom)
c. Proportion of fetal head palpable within the abdomen compared with proportion that has
descended into the pelvis is described in fifths:
i. 5/5: head is completely free and mobile within abdomen
ii. 4/5: head is beginning to enter the pelvic brim
iii. 3/5: most of head is within the pelvic brim
iv. 2/5: the widest diameter of the head has passed through the pelvic brim
v. 1/5: minimal portion of head palpable abdominally
d. Head is engaged when widest part (biparietal diameter) has passed through pelvic inlet

5. Fetal Heart (110 – 160bpm)

a. Pinnard or Doppler can be used to detect the fetal heart
b. Best heard: anterior shoulder of the fetus

LOWER LIMBS EXAM

1. Oedema
2. Varicose veins
3. Evidence of DVT:
a. Erythema
b. Pain
c. Swelling
d. Heat

VAGINAL EXAM
1. Sterile Speculum
Examination Indications:
a. To confirm spontaneous
rupture of membranes
(in this case, amniotic
fluid may be seen forming a pool in the posterior vaginal fornix)
b. To assess vaginal bleeding in pregnancy
c. To assess cervical dilatation in preterm labour
2. Digital Vaginal Examination Indications:
a. To confirm the diagnosis of labour
b. To assess cervical favorability for induction of labour
 c. To assess the progress in labour

3. Position of the cervix: posterior/ mid-position/ anterior

4. Consistency: firm/ medium/ soft
5. Cervical Length or effacement: in cm or %
6. Dilatation: of the cervix in cm
7. Station: of the fetal head in relation to ischial spines