Obstetric abdominal examination
- stand on the right side to the patient (examiner may set on the right side to see if you will ask him/her to stand there)
- Patient position not flat, semi setting. Be sure that her legs are not crossed.
- Say: the proper exposure is from the (nipple/sternum) to the middle of the thigh, but for the patient convenience I will expose the abdomen only.
- Inspection:
Distention
Asymmetry: dextrorotatory to the right is normal.
Umbilicus (flat)
linea nigra (black line)
New striae (pink)
Old striae (white)
Any hypo/hyper pigmentation
Scars (surgical scars: e.g: c-section scar easily missed if you don't expose the lower abdomen or see under the distended lower abdomen above the symphysis pubic… if u missed it>> you will fail !! ,cauter , burn,… other)
Dilated vein
Hernial orifices (umbilical, femoral, inguinal); put your finger in it & ask her to cough
Hair distribution (female or male hair distrbution)
Visible fetal movement
Palpation: -
- ask her if there is any pain in her abdomen, to start away from it.
- start gently with superficial palpation (usually they prefer to start from the right iliac fossa), sup. Palp. is to establish contact between doctor & patient, and to detect any tenderness (placenta tenderness)
Fundal height:
- From 20-38 weeks, it is in cm +/- 2 gestational ages in weeks
- Start from the sternum, put your hand on the ulnar edge & press gently inferiorly. Repeat it again, each time put your hand at a lower level till you feels the first resistance indicate the upper part of the fundus, fix your hand at this level. With the other hand put the measuring tape from this point to the symphysis pubic (should be exactly on it, on the bony part). Measure the height in cm (it is better to put the measuring tape on the inch side during measuring, then turn it to cm to see the reading ... to exclude bias).
Leopold's Maneuvers
1- Fundal grip:
Determine what fetal part is at uterine fundus (gently, whole hand)
e.g.: soft, wide, irregular = breech
2-lateral grip:
Fix one hand & palpate with the other hand, then reverse.
-irregular + groove =limps
- Broad like, smooth = back (here you can lessen to the heart)
3-pelvic grip:
1st pelvic grip ... Determine the presenting part (Which occupy pelvic)
- Make a "V" with your thumb and index finger and pressing down just above the pubic bone, feel the hard fetal head at the pelvic inlet by move your hand at wrest joint.
e.g.: Head= hard, globular, floatable.
2nd pelvic grip ... engagement
- Examiner faces woman's feet. Palpate just above symphysis pubis, palpate fetal prsesnting part between two hands, & assess for fetal descent.
# (fig.) show Leopold's maneuvers.
Auscultation:
Fetal heart
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**NOTE:
- This is written from a session
- This is only the abdominal examination without the general & the rest systems
