BISMILLAHIRRAHMAANIRRAHIIM

Obstetric Examination
SITI ANNISA DEVI TRUSDA
Skills Lab – FK Unisba
Obstetric Examination

Part of Antepartum Assessment, goal : to prevent fetal death

Obstetric Examination technique:
Vaginal Examination

Palpation

Auscultation

Imaging Studies

(depend on indication and gestational age)

Obstetric Examination

To assess:

Signs of pregnancy
Gestational age
Fetal structure and fetal condition
Fetal presentation and position
Obstetric Examination in General

- History taking

- Informed Consent

- Preparation

- General Examination

- Getting Ready
Obstetric Examination for Early Pregnancy
1st Trimester

- Wash the hands with soap, and dry with clean dry towel

- Inspect suprapubic bulging and try to palpate uterine

fundus. Locate mass or abdominal tenderness.

- Wash the hands with soap, and dry with clean dry towel

- Putting on handgloves
- Sitting on a chair the physician faces genital aspect of the patient
- Take some cotton and antiseptic solution and wipe it on the
examining area
- Performs speculum examination
- Notice the color change of the vaginal wall, which usually turn
bluish (Chadwick’s sign).
- Notice the shape and size of portio, fornices, the vaginal wall, also
any secret from the ostium.
- Pay attention to any abnormalities
- Perform bimanual examination
- Define the uterine size
- Move your fingers (inside and outside) to the
isthmic level and let them meet. Try to find Hegar
sign
- Performs cervical motion tenderness
Hegar’s sign
Piskacek’s sign
Obstetric Examination for 2nd Trimester

- Wash the hands with soap, and dry with clean dry towel

- Inspect suprapubic bulging and try to palpate uterine fundus.

Locate mass or abdominal tenderness.

- Palpation of fundal height

- The rule of Forth:

 12 week : 2 fingers above symphisis
 16 week : middle way from symphisis to navel
 18-20 weeks : 2 fingers below the navel
 24 weeks : at the navel
- Fundal height measurement by measuring tape is applicable only
for gestational age 18 and more. Result of FH measurement is
in accordance with gestational age from 18 to 32 week
- Ballotement in toto
- Auscultation of Fetal Heart Beat, using ‘monoaural stethoscope’
or ‘doptone’
- Choose an area with the clearest pulse.
- When abdominal thinckness interfered with this, put the conus
base at the thinner area ,i.e. 3 cm below the umbilicus.
Ballotement
- Listen and count the fetal heart sound every other 5
second, do it three times with 5 second interval each
- Sum the result and multiply by four to have the
approximate fetal heart rate per minute.
- Note the differences in the 5-second counts, it can be
used for monitoring irregularity rhythm.
- Others sound can be heard while auscultation, such as:
vascular bruit, intestinal bruit, umbilical sound, and
mother’s heart beat.
Obstetric Examination for 3 rd

Trimester
 Fundal height measurement
- Reposition the uterus and the baby until it is
confirmed in the mid line.
- Mark the fundus and place the tip of measuring
tape on the mid line at the fundus level. This will
be the starting point.
 Leopold Maneuvers
 Auscultation of the fetal heart beat
 First Maneuver

What part is in the fundus?

 Facing the mother, palpate the fundus with both hands

◦ Assess for shape, size, consistency and mobility
Fetal head: firm, hard, and round
 Moves independently of the rest
 Detectable by ballotement

Buttocks/breech: softer and has bony prominences

 Moves with the rest of the form
Second Maneuver
Determine position of the back.

 Still facing the mother, place both palms on the

abdomen
 Hold R hand still and with deep but gentle pressure, use
L hand to feel for the firm, smooth back
◦ Repeat using opposite hands
 Once you’ve located the back, confirm your findings by
palpating the fetal extremities on the opposite side
(“lumpy”)
 Third Maneuver

Determine what part is lying

above the inlet.

 Gently grasp just above symphisis pubis with the thumb

and fingers of the R hand
 Confirm presenting part (opposite of what’s in the
fundus)
◦ Head will feel firm
◦ Buttocks will feel softer and irregular
 If it’s not engaged, it may be gently pushed back and forth
◦ Proceed to the 4th step if it’s not engaged…
Fourth Maneuver
Flexed/Deflexed/Extended?

 Turn to face the woman’s feet

 Move fingers of both hands gently down the sides of the
abdomen towards the pubis
 Palpate for the cephalic prominence (vertex)
◦ Prominence on the same side as the small parts
suggests that the head is flexed (optimum)
◦ Prominence on the same side as the back suggests
that the head is extended
Engagement
 Determined by the amount of head that is
above or below the pelvic brim

 This is usually done by dividing the head into

”fifths”
◦ if the head is still palpable abdominally, it is “2/5” or
less engaged

 Stations of Presentation
The head is 'engaged' - this is when 2/5 or less of the baby's head can be 'felt' (palpated) above
the brim. This may not happen until the mother is in labour. If all of the baby's head can be felt
above the brim, this is described as 'free' or 5/5 'palpable'.
- Data Recording and Final Conclusions
- Management Plan
 (Result, Gestational age, Additonal examination,
follow-up visit, alarming sign)
ALHAMDULILLAH

Thank You