Obstetric physical examination

1. Obstetric physical
examination
In the initial presentation,
full physical examination
should be done.
Abdominal & pelvic
examination remains
important exam for
pregnant women because it
is the easiest method of
fetal monitoring.

2. Essential definitions that you should
know to understand the physical
eTxhaem prienseanttaitoionn : fisi nthde ipnargt sof:
the fetus in the lower pole of the
uterus overlying the pelvic brim
(cephalic, breech)

3.  The lie of the fetus: is the relation of the long axis of the fetus to the
uterus (could be longitudinal, oblique or transverse. only longitudinal lie is
normal)

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

5.  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

6. 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
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, polyhydramnios
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.
 Fetal movement
 Contour of the abdomen: full bladder may be visible in
late pregnancy. Umbilicus may become everted
 Skin changes: look for stretch marks, linea nigra, scars that
indicates previous surgeries

8. Method of abdominal exam
 Palpation: by Leopold maneuver-4 maneuvers
 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 sixe
 If can’t move independent from the body  breech
 If moves freely between fingertips  head

9. Method of abdominal exam
 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.

10. Method of abdominal exam
 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 @ the same
side of the back & sincipital @ the opposite side of
the back)
 If the sinciput is higher the occiput  well flexed
 If both prominances are at the same level  deflexed
 If can’t palpate the prominances, and the bulk of the head is
felt at the same side of the back  extended

11. occiput
siniciput)

12. Method of abdominal exam
 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 exam (details of pelvic
exam will be discussed in
gynecological exam) but
important landmarks to
notice during pelvic exam
are
 Pubis symphasis
 Ischial spine

13. After you examine a pregnant women 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.

14. After you examine a pregnant women you
should answer the following questions
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?

15. Examination during labor
1. Palpate uterine contractions
2. Assessment of the cervix dilatation
• 1 finger  1-2 cm dilated
• 2 fingers  3-4 cms dilated
• 3 fingers  5-6 cms dilated
• 4 fingers  7-10 cms dilates

16. 3. Effacement of the cervix: thinning of the cervix (%) or length (cm). The
cervix is normally 3-5 cms. If cervix is about 2 cm from external to
internal os  50% effaced
50% effaced 100% effaced

17. 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