OBSTETRIC PHYSICAL EXAMINATION (YEAR 3)

LONG CASE 1 (PROF EHAB)

GENERAL EXAMINATION
General Introduce, explain, consent, chaperone, good lighting.
inspection Alert & conscious, not in respiratory distress, pain, & looking cachexic
Lying comfortably supine supported with 1 pillow
Hand No palmar pallor, palmar erythema, slightly clubbing, normal capillary refilling
time, peripheral cyanosis
Eye No conjunctival pallor, yellow discoloration of sclera
Mouth No central cyanosis, good hydration, good oral hygiene
Neck No thyroid enlargement
No enlarged lymph node
Leg No oedema (bony prominence), varicose veins (above/bellow knee), DVT (calf
tenderness, redness, hotness-temperature, hardness-swelling)
Reflexes (knee/brachial): neuro deficit
Cardiovascular S1, S2 can be heard
No added sound (murmurs/gallop rhythm)
Respiratory Normal respiratory rate (12-16 bpm)
Bilateral air equal entry and vesicular breath sound
Added sounds (crepitation, ronchi..)
Breast Bilateral symmetry
Nipple (inverted/everted/flat)
No nipple discharge
Skin (smooth, ulcer, discoloration, peau d’range…)

SHORT CASE 1 (DR WIN WIN)

ABDOMEN EXAMINATION
Inspection • Abdomen is distended
• Asymmetry more to the right side
• Umbilicus centrally located and inverted/everted/flat
• Uniformly (if symmetry) distended with gravid uterus – by the evidence of
cutaneous sign of pregnancy such as striae gravidarum, linea nigra,
hyperpigmented umbilicus, dilated/visible vein (lateral), flank fullness
• No surgical scar
*If have: (There is longitudinal surgical scar (longitudinal/transverse) at the
suprapubic area which is heal by primary intention)
• Measure scar (17cm)
• Hernia orifices are intact & no incisional hernia (if got scar)
Palpation 1. No scar tenderness (skin incision: upper/lower segment)
• Put at the scar and cover the upper part (whole hand) & look patient’s
face
• 1 finger below & 1 finger above & look patient’s face
2. Clinical fundal height
• 36 weeks
3. Symphysis
• 32 cm
4. Fundal grip
• It is soft, broad, irregular, non-ballotable suggestive → fetal buttock
5. Right lateral grip
• It is small, irregular, knobby & recede on pressure suggestive → fetal
limbs
6. Left lateral grip
It is smooth, curve, hard & resist on pressure suggestive → fetal back
7. Pelvic grip
 • It is small, round, hard and ballotable suggestive → fetal head
8. Engagement fetal head
• 2 fingers palpable → head is engaged
Auscultation • Left side on fetal back over the shoulder
• Point midway between umbilicus & ASIS
• FHS is strong, regular, and asynchronous with maternal pulse
(140bpm)
Summary This woman is singleton, viable pregnancy, 32 weeks of gestation, longitudinal
line, cephalic presentation, with 2/5th palpable, FHS can be heard at the point
midway between umbilicus & ASIS which is strong, regular, and asynchronous
with maternal pulse.
Liquor amount clinically adequate.
EFW is 32weeks (1.5 – 1.7kg).

PROF EHAB:

24 weeks 0.5 – 0.7

28 weeks 1 – 1.2

32 weeks 1.5 -1.7

34 weeks 2 -2.2

36 weeks 2.5 – 2.7

38 weeks 3 – 3.5

40 weeks 3.5 -4