From 18 weeks, the SF height must be plotted on the SF growth curve to determine the gestational age. This method is, therefore, only used once the fundal height has reached 18 weeks.

In other words, when the SF height has reached 2 fingers width under the umbilicus. The lie and presenting part of the fetus only becomes important when the gestational age reaches 34 weeks.

There are four specific steps for palpating the fetus. These are performed systematically. With the mother lying comfortably on her back, the examiner faces the patient for the first three steps, and faces towards her feet for the fourth. Figure 1B An accurate method of determining the amount of head palpable above the brim of the pelvis.

This is not always easy to feel. The amount of liquor decreases as the pregnancy nears term. The amount of liquor is assessed clinically by feeling the way that the fetus can be moved balloted while being palpated. In many cases, however, the cause of polyhydramnios is unknown. However, serious problems can be present and the patient should be referred to a hospital where the fetus can be carefully assessed.

The patient needs an ultrasound examination by a trained person to exclude multiple pregnancy or a congenital abnormality in the fetus. This means that the uterus feels tight, or has a contraction, while being palpated. Uterine irritability normally only occurs after 36 weeks of pregnancy, i. If there is an irritable uterus before this time, it suggests either that there is intra-uterine growth restriction or that the patient may be in, or is likely to go into, preterm labour. If there is a reason for the patient to count fetal movements and to record them on a fetal-movement chart, it should be done as follows:.

Every time the fetus moves, the patient must make a tick on the chart so that all the movements are recorded. The time and day should be marked on the chart.

If the patient is illiterate, the nurse giving her the chart can fill in the day and times if the chart is to be used more than once a day. It is important to explain to the patient exactly how to use the chart. Remember that a patient who is resting can easily fall asleep and, therefore, miss fetal movements. It is very important to assess the state of fetal wellbeing at the end of every abdominal palpation.

This is done by taking into account all the features mentioned in this skills chapter. Bettercare Learning Programmes Maternal Care 1b. Skills: Examination of the abdomen in pregnancy. Measure the symphysis-fundus height. Assess the lie and the presentation of the fetus. Assess the amount of liquor present.

obstetric examination steps

Listen to the fetal heart. Assess fetal movements. Assess the state of fetal wellbeing.We have short-term or long-term volunteer opportunities, so you can select a project that best fits your life. Ensure your entire team is prepared to deliver evidence-based, standardized care.

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Join Us. Get Started. Get Involved. Read More. Online Courses. Access your education or see the certificates for education you have completed. Access Now. Donate Now. Become a Member. Join Today. Hospital Products. Patient Education.Ideally, women who are planning to become pregnant should see a physician before conception; then they can learn about pregnancy risks and ways to reduce risks.

As part of preconception care, primary care clinicians should advise all women of reproductive age to take a vitamin that contains folic acid to mcg 0.

Folate reduces risk of neural tube defects. If women have had a fetus or infant with a neural tube defect, the recommended daily dose is mcg 4 mg. Taking folate before and after conception may also reduce the risk of other birth defects 1. Once pregnant, women require routine prenatal care to help safeguard their health and the health of the fetus.

Also, evaluation is often required for symptoms and signs of illness. Common symptoms that are often pregnancy-related include. Vaginal bleeding. Pelvic pain. Lower-extremity edema.

Specific obstetric disorders and nonobstetric disorders in pregnant woman are discussed elsewhere. Prenatal visits may be scheduled more frequently if risk of a poor pregnancy outcome is high or less frequently if risk is very low. Am J Med Genet —, Risk factors for complications of pregnancy see table Pregnancy Risk Assessment.

Obs & Gynae

Obstetric history, with the outcome of all previous pregnancies, including maternal and fetal complications eg, gestational diabetes, preeclampsia, congenital malformations, stillbirth. Family history should include all chronic disorders in family members to identify possible hereditary disorders genetic evaluation.

During subsequent visits, queries focus on interim developments, particularly vaginal bleeding or fluid discharge, headache, changes in vision, edema of face or fingers, and changes in frequency or intensity of fetal movement. Gravidity is the number of confirmed pregnancies; a pregnant woman is a gravida. Parity is the number of deliveries after 20 weeks. Multifetal pregnancy is counted as one in terms of gravidity and parity.

obstetric examination steps

Abortus is the number of pregnancy losses abortions before 20 weeks regardless of cause eg, spontaneous, therapeutic, or elective abortion; ectopic pregnancy. Sum of parity and abortus equals gravidity. Thus, a woman who is pregnant and has had one term delivery, one set of twins born at 32 weeks, and 2 abortions is gravida 5, para A full general examination, including blood pressure BPheight, and weight, is done first.

Body mass index BMI should be calculated and recorded. BP and weight should be measured at each prenatal visit.A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes.

A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations.

A comprehensive collection of medical revision notes that cover a broad range of clinical topics.

Pregnant Abdomen Examination

A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Some of the questions are highly personal and therefore good communication skills and a respectful manner are absolutely essential.

A patient is currently 26 weeks pregnant and already has two other children of her own. She also reports having had a miscarriage at 10 weeks and a stillbirth at 28 weeks. Once the patient has had time to communicate their presenting complaint, you should then begin to explore the issue with further open and closed questions. We have included a focused list of the key symptoms to ask about when taking an obstetric history, followed by some background information on each, should you want to know a little more.

Nausea and vomiting are very common in pregnancy but are usually mild and only require reassurance and advice. Nausea and vomiting in pregnancy usually begin between the fourth and seventh weeks of gestationpeaks between the ninth and sixteenth weeks and resolves by around the 20th week of pregnancy. Persistent vomiting and severe nausea can progress to hyperemesis gravidarum. Hyperemesis gravidarum refers to persistent and severe vomiting leading to dehydration and electrolyte disturbance, weight loss and ketonuria.

Women should start to feel fetal movements between 16 to 24 weeks gestation. Primigravida women will often not feel fetal movements until after 20 weeks gestation. Reduced fetal movements are associated with adverse pregnancy outcomes, including stillbirthfetal growth restrictionplacental insufficiencyand congenital malformations.

You should therefore always ask about fetal movements one the patient is of the appropriate gestation to be able to feel them:. Abnormal vaginal bleeding is an important symptom that can be relevant to a wide range of obstetric and gynaecological diseases.

You should also ask about fatigue if anaemia is suspected and symptoms of hypovolaemic shock e. All healthy women will have some degree of regular vaginal discharge, so it is important to distinguish between normal and abnormal vaginal discharge when taking an obstetric history. You should ask if the patient has noticed any changes to the following characteristics of their vaginal discharge :.

Urinary tract infections are common in pregnancy and need to be treated promptly. Untreated urinary tract infections in pregnancy have been associated with increased risk of fetal death, developmental delay and cerebral palsy. Pre-eclampsia is a relatively common condition in pregnancy which is characterised by maternal hypertension, proteinuria, oedema, fetal intrauterine growth restriction and premature birth.

The condition can be life-threatening for the mother and the fetus. As a result, it is essential to ask about symptoms of pre-eclampsia as part of every patient review during pregnancy. Clarify the current gestational age of the pregnancy e.

You should ask about the results of the scan or check the medical records if the patient is unsure.A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes.

A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes.

A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations.

A comprehensive collection of medical revision notes that cover a broad range of clinical topics. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management.

A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Clinical Examination. Anatomy of the Uterus.

Prescribing in Primary Care. Interpreting a Coagulation Screen. A collection of surgery revision notes covering key surgical topics.

Hilum of the Lung. Spinal Cord Summary. A man with blood in his urine. A man with testicular pain. Medical Student Finals Questions. ABG Quiz. Thyroid Pathology Quiz.

Dr James Nott.Examination of the pregnant abdomen is performed routinely throughout pregnancy. Expectant mothers attend ante-natal check-ups regularly throughout their pregnancy where this is performed by both doctors and midwives.

You will get the chance to practice this skill during your obstetrics and gynaecology placement in medical school, however as you will likely encounter pregnant women in whatever area you specialise in, it is an essential skill to be able to perform.

As such it is commonly examined in OSCEs. There will usually be real patient volunteers for this station so remember to be gentle as your patient may have had her bump examined many times before your turn.

Like most stations this still follows the general rule of:. Wash your hands. Explain what you would like to do and gain her consent. For this station the patient should be lying on the bed, as flat as possible but in reality whatever is most comfortable for her. She should ideally be exposed from the pubic bone to below her breasts.

Try and put mum at ease. A few simple but friendly questions to help her gain your trust includes:. This shows the examiner that you can be caring, rather than jumping in hands first. As you become more skilled at this station you can incorporate these types of questions into your examination technique along the way.

Perform a general inspection of mum and her bump. Comment whether she looks comfortable, does she have any abdominal striations or Linea Nigraand whether she has previous operative scars, such as previous caesarean section. If greater than 24 weeks you can expect some foetal movements, comment if so.

This shows you really are observing her closely. Measure fundal height.

obstetric examination steps

Do this with a tape measure disposable if available. Measure from the pubic symphysis to the top of her bump fundus. The length in centimetres roughly corresponds to how far along she is in weeks; for example 36cm roughly equals 36 weeks. Check the lie of the baby by examining her bump.

Remember to be gentle and warm your hands if they are cold. Here you are assessing which way the baby is lying — this can be longitudinal, transverse or oblique. Use both hands, one on each side of her bump and gently press. Remember to face mum while you are doing this.The obstetric examination is a type of abdominal examination performed in pregnancy. It is unique in the fact that the clinician is simultaneously trying to assess the health of two individuals — the mother and the fetus.

In this article, we shall look at how to perform an obstetric examination in an OSCE-style setting. Fig 1 — Skin changes in pregnancy. A Linea nigra. B Striae gravidarum and albicans. Ask the patient to comment on any tenderness and observe her facial and verbal responses throughout.

Note any guarding. Once you've finished editing, click 'Submit for Review', and your changes will be reviewed by our team before publishing on the site.

Introduction Introduce yourself to the patient Wash your hands Explain to the patient what the examination involves and why it is necessary Obtain verbal consent. General Inspection General wellbeing — at ease or distressed by physical pain.

Hands — palpate the radial pulse. Head and neck — melasma, conjunctival pallor, jaundice, oedema. Legs and feet — calf swelling, oedema and varicose veins. Palpation Ask the patient to comment on any tenderness and observe her facial and verbal responses throughout. Fundal Height Use the medial edge of the left hand to press down at the xiphisternum, working downwards to locate the fundus.

Measure from here to the pubic symphysis in both cm and inches.

obstetric examination steps

Turn the measuring tape so that the numbers face the abdomen to avoid bias in your measurements. Uterus should be palpable after 12 weeks, near the umbilicus at 20 weeks and near the xiphisternum at 36 weeks these measurements are often slightly different if the woman is tall or short.

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Obstetric examination steps

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