Obstetric Examination


Now let’s see how to examine an obstetric patient. The first thing is the position. Ensure that the patient is laying in supine position with her knees slightly bent if necessary. And then expose her from the xiphisternum to the pubic symphysis. And ensure that your hands are clean and warm. The first thing you have to do is to measure the symphyseal fundal height, so for this, we need to feeling the uterine fundus, so to feel the uterine fundus, you use the ulnar surface of your palm, and start from the xiphisternum, and slowly work your way down, and stop when your hand meets the first [INAUDIBLE] of resistance. OK. So that is going to be your fundus. Now use your tape measure. Keep the centimeter side away from you, and this is just to avoid bias. And now feel the pubic symphysis. You may have to warn the mother at this point, because it may be a bit uncomfortable when you press on the pubic symphysis. OK, and you can measure right up to the pubic symphysis. And flip your tape. So that shows 36 centimeters, isn’t it? We know that this lady’s 36 weeks, so this corresponds to her gestation. Now let’s move on to the [INAUDIBLE] maneuvers. So let’s do the first maneuver. The first maneuver is used to find out what is presenting in the frontal region. So use the palm of both your hands, and feel. So what are you feeling now? I feel a small firm surface. This moves with the rest of the fetal body, so this slightly corresponds to the baby’s bump. Yeah, OK. Now let’s do the second maneuver. So use one hand to stabilize the uterus, and your other hand, you have to feel from the top right down to pubic symphysis. So what do you think you’re feeling there? I feel multiple small and [INAUDIBLE] parts. This could correspond to the fetal limbs. Now stabilize that hand, and use your other hand, and then feel beginning from the top to the bottom. So what do you think you’re feeling now? I feel a smooth continuous surface, and this would likely correspond to the fetal back. OK. So now let’s go on to the third one, so for the third maneuver, you have to open your hand as wide as you can, and just above the pubic symphysis, gently grab, and gently rock. You may have to warn the mother again that this can be painful. So what do you feel now? I now feel a smooth but hard surface. This is likely to be the fetal head. So this makes sense, because we felt the baby’s bottom at the top, so you would expect to feel the baby’s head as a presenting part. Now let’s move into the fourth maneuver, so for this one, you have to turn the other way around, and face the patient’s feet, and use both your hands, and just feel just above the pubic symphysis. You may have to bend your elbow. [INAUDIBLE] if you palpate [INAUDIBLE], and it will go into spasm, and it’s difficult to feel what’s underneath it. So what do you feel now? I think I was unable to [INAUDIBLE] with the presenting part. However, I can feel most of the fetal head, so this is likely to be 4/5 palpable. Yeah. And it also confirms that it is a head when you feel it. So your fourth maneuver confirms what you have seen in the third maneuver, and it also helps us to work out how far the baby’s head had gone into the pelvis, and when your hands meet underneath the presenting part, it’s 5/5 palpable. And as you said, when you feel most of the presenting part, but your hands still, they’re not meeting down, then it’s 4/5 palpable. So if it’s 3/5 palpable, you will feel equal amount of head on both sides. And if you don’t feel anything at all, it is 0/5 palpable. If you feel the head on one side and not on the other side, it’s 1/5 palpable. Now let’s move on to osculating the fetal heart. So given that the fetus is in a cephalic presentation, and the fetal back is on the maternal right, I’ll actually listen to the fetal heart. I’ll locate it using the [INAUDIBLE]. I’ll confirm it’s on the right and below the umbilicus. Yes. So the fetal heart rate is around 150 beats per minute. So how do you like to summarize your findings? So in summary, my obstetric examination reviews longitudinally distended [INAUDIBLE] uterus, and the symphyseal fundal height is about 36 here, which corresponds to the fetal gestation. The fetus is in a longitudinal line, and cephalic presentation, and the head is about 4/5 palpable. The fetal heart rate can be picked up at about 150 beats per minute. Yeah. OK. So this is how you would summarize an obstetric examination.

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