Describing the obstetrical examination of a pregnant woman.

1. Obstetric
physical
examination
‫شادکام‬ ‫حمیرا‬
‫مهدیه‬ ‫بیمارستان‬ ‫استاژر‬

2. Essential definitions
The Presentation: is the part of the fetus in the
lower part of the uterus overlying the pelvic brim(
cephalic, breech )

3. The attitude: is the posture of the fetus( flexion,
deflexion, extension)

4. The position: of the baby in relation to the
presenting part of the mother’s pelvis. It is
expressed according to the denominator which
is:
Occiput in vertex presentation
Sacrum in breech presentation
Mentum in face presentation

5. Station & engagement
station: is the relation of the presenting part to
the ischial spine. If the presenting part is at the
level of ischial spine, station=0

6. 
Engagement: the descent of the biparietal

diameter through pelvic brim. If the head is at

the level of ischial spine the head must be
engaged.

7. Method of abdominal exam
Inspection:
Size of the uterus: assess
If the length & breadth are both increased:
multiple pregnancies, poly hydramnios
If the length is increased only: large baby
Shape of the uterus: length should be larger
than broad this indicates longitudinal lie. but if
the uterus is low and broad indicates transverse
fetus lie.

8. Fetal movement
Contour of the abdomen: full bladder may be
visible in late pregnancy. Umbilicus may
become overted.
Skin changes: look for stretch marks, linea
nigra, scars that indicates previous surgeries.

9. Palpation: by leopold maneuver
Palpate the fundus(to determine if it contains
breech, head)
By gentle pressure:
If soft consistency/ indefinite outline: breech
If hard, smooth, well defined: head
Move your fingertips over the fetal mass to
determine mobility and size.
If cant move independent from the body: breech
If moves freely between fingertips: head

10. Lateral palpation: (determine the position of
the fetal back and small parts)
Hands are placed on each side of the umbilicus.
The fetal spine will palpate as firm, flat and
linear. The fetal extremities are palpable by their
varying contour and movements. The purpose
of this maneuver is to determine whether the
fetal back is left or right.

11. Pelvic palpation: 2 maneuvers
Grasp the lower poles of the uterus between fingers
and thumbs and comment of the size, flexion and
mobility of the head.
To determine the position of the vertex presentation:
try to palpate the prominences ( occiput at the same
part of the back and sincipital at the opposite side of
the back)
If the sinciput higher the occiput: well flexed
If both prominences are at the same level: deflexed
If cant palpate the prominences, and the bulk of the
head is felt at the same side of the back: extended

13. Auscultation: help assess fetal well being
Auscult the whole abdomen trying to locate the
point of maximum intensity
Don’t forget to perform a pelvic exams but
important landmarks to notice during pelvic
exam are:
Pubis symphasis
Ischial spine

14. After you examine a pregnant woman
you should answer the following
questions
1. What is the fundal height?
It is estimated by centimeters from upper border of the
fundus to the pubis symphasis by taping measure. The
height of the fundus correlates well with the gestational
age especially during the weeks of pregnancy.

15. 2. Lie of the fetus: only longitudinal lie is
normal
3. Attitude: normally it is full flexion and every
fetal joint is flexed
4. Presentation: normally cephalic
5. Position: according to the dominator
6. Is the vertex engaged?

16. Examination during labor
1. palpate uterine contractions
2. assessment of the cervix dilatation
1 finger: 1-2 cm dilated
2 fingers: 3-4 cm dilated
3 fingers: 5-6 cm dilated
4 fingers: 7-10 cm dilated

17. 3.Effacement of the cervix: thinning of the
cervix(%) or length(cm). The cervix is normally
3-5 cm. if cervix is about 2 cm from external to
internal os: 50% effaced

18. 4. consistency of the cervix: soft vs. hard.
During labor the cervix becomes soft.
5. position of the cervix: posterior vs. anterior.
During labor the cervix changes from posterior
to anterior.
6. membrane is intact or ruptured: assessed
by fluid collection in the vagina.

19. Thank You