Wayne Robinson, MBBS Class of 2015

Obstetric Examination Outline

For OSCE – May do a “running commentary” then summarize findings again at the end.
July 2014

1. Introduce yourself – Ask patient name, permission to examine

2. Expose patient – Comment on why only exposing the abdomen

3. Start at foot of the bed – INSPECTION

A. General:
- Eg. Young, gravid female
- Distress?
- Adequate nutrition?
B. Abdomen:
- Globally distended abdomen? (consistent with gravid uterus?)
- Scars? - ***Make sure to look specifically for a Pfannenstiel! May have to lift belly! It is not always obvious!!
- Notable linea nigra?
- Notable striae gravidarum? (New striae = hyperpigmented. Old = hypopigmented)
- Umbilicus – inverted, flat, everted?
- Movement with respiration?
- Hair distribution?
- Fetal movements seen?
C. Legs:
- Ask patient about pain before touching
- Pedal oedema?

4. ABDOMEN PALPATION [Leopold’s maneuvers]

FIRST MUST: ASK IF ANY PAIN! Can palpate abdomen for – Soft, tense, tender? THEN Leopold’s maneuvers

A. Do #1 [Fundal grip] – then feel for the part/pole at the fundus [Describe: Head = “round, firm”. Breech = “Irregular, soft”]
- Measure symphysiofundal height [**Start tape measure FROM sup. bord. of PS to fundus – ie. Say “measuring
from the fixed point to the mobile point”]
- Measure SFH on inches side but report in cm [Say reason: “to eliminate bias”]
- Ask patient to put finger to mark the point of fundus while you measure

B. Do #2 [Lateral/Umbilical grip] – Ensure to feel for:

- Number of fetuses
- Fetal back [Described as: Smooth, convex, regular]
- Fetal limbs [Described as: Irregular, concave?]
- Lie of fetus
- AUSCULTATE fetal heart

C. Mention “I will bypass Pawlik’s grip [#3]” [Must still demonstrate how you would do it AND SAY the 2 reasons: 1. Painful 2.
Gives no additional information that Leopold’s (other) maneuvers will not provide]

D. Do #4 [Pelvic grip] – and ballot presenting part

- “Feel for fifths”
- Then +/- fluid thrill for polyhydramnios Summary example:

Remainder of examination: “In summary, I found a gravid female:

5. Hands – pallor 1. Symphysiofundal height of …
- Pulse 2. Singleton pregnancy
- ASK for BP
3. Longitudinal lie
6. Face: Eyes – mucous membranes and Icterus 4. Cephalic presentation
- Mouth – mucous membranes! 5. Fetal back on the maternal right, limbs on the
left
7. ASK for urinalysis results AND weight!! 6. Appreciated fetal heart in the left iliac fossa,
with a rate of 136 bpm
8. Thank patient and cover 7. Head was not engaged”
9. Comment on findings 8. May also estimate amniotic fluid volume