Obstetric examination

Question 1

What equipment do you need and what should you offer the patient before starting?

Answer 1

1. Tape measure
2. Pinard stethoscope
3. Offer patient to go to the loo

Question 2

What should you look for on general inspection of the patient?

Answer 2

-PAIN (appears uncomfortable?)
-OBVIOUS SCARS (previous abdo surgery?)
-PALLOR (anaemia)
-JAUNDICE (obstetric cholestasis)
-OEDEMA (widespread, pre-eclampsia)

Question 3

What should be assessed in the hands of the patient?

Answer 3

INSPECT (colour, ?oedema, palmar erythema)
TEMPERATURE
CRT
RADIAL PULSE (NB higher baseline than normal)

Question 4

What should be assessed in the face of the patient?

Answer 4

JAUNDICE
MELASMA (normal)
OEDEMA (normal in late but ?pre-eclampsia)
CONJUNCTIVAL PALLOR

Question 5

How should the patient be positioned to inspect the abdomen?

Answer 5

EARLY = supine with 15-30 degrees elevation
LATE = left lateral position, tilted to 15 degrees

Question 6

What should you look for on close inspection of the abdomen?

Answer 6

SHAPE (indication of foetal lie)
FOETAL MOVEMENTS (visible from 24 weeks)
SURGICAL SCARS
LINEA NIGRA (normal)
STRIAE GRAVIDARUM (stretch marks)
STRIAE ALBICANS (mature stretch marks)

Question 7

How should you palpate in the abdomen?

Answer 7

ABDOMEN
-Light palpation over all 9 regions
UTERUS
-Palpate borders
-Fundus will be at different locations at different gestations:
–12 weeks = pubic symphysis
–20 weeks = umbilicus
–36 weeks = xiphoid process of sternum

Question 8

How should you palpate the foetus?

Answer 8

FOETAL LIE
-Place hands on either side of uterus (facing patient)
-Gently palpate each side of uterus (one side should feel back, other side should feel limbs)
FOETAL PRESENTATION (which anatomical part is closest to pelvic inlet)
-Apply pressure either side of lower pole of uterus
-Hard + round = cephalic, broad + soft = breech
FOETAL ENGAGEMENT
-If able to feel entire head = 5/5 engaged
-If not able to feel head = 0/5 engaged
-Engagement = >50% of presenting part has descended into the pelvis
SYMPHYSEAL-FUNDAL HEIGHT
-After 20 weeks, gestational age = SFH +/-2cm
-Locate fundus using ulnar aspect of hand
-Measure distance between fundus and upper border of pubic symphysis

Question 9

How do you assess the foetal heartbeat?

Answer 9

-Aim to place between foetal shoulders on foetal back
-Palpate maternal pulse
-Place ear to stethoscope and take hand away

Question 10

How is obstetric cholestasis characterised?

Answer 10

-Abnormal LFTs
-Jaundice
-Intense pruritis
-Presents in 3rd trimester and increases risk of IUD and premature delivery

Question 11

What is aortocaval compression syndrome?

Answer 11

-Compression of aorta and IVC
-Can result in maternal hypotension, loss of consciousness and foetal demise

Question 12

What are the different types of foetal lie?

Answer 12

-Longitudinal lie = head and buttocks are palpable at each end of the uterus
-Oblique lie = head and buttocks are palpable in one of the iliac fossae
-Transverse lie = foetus lies directly across the uterus