Examination in Pregnancy

Abdomen;

Position; semirecumbent position, cover hip below with blanket.

Inspection;

Shape of uterus (gavid uterus) and asymmetry Fetal movement Scars – caesarean scar Striae gravidarum, linea nigra

Palpation;

Symphysis-fundal height (SFH) measuremento Place tape from symphysis pubis to top of fundus, turn the tape to read the

measuremento Length is correspond with geattaional age

o Large SFH = macrosomia, multiple pregnancy, polyhydramnios

o Small SFH = IUGR, oligohydromnios

Leopold's Maneuvers o First Maneuver (Upper pole)

Examiner faces woman's head

Palpate uterine fundus

Determine what fetal part is at uterine fundus

o Second Maneuver (Sides of maternal abdomen)

Examiner faces woman's head

Palpate with one hand on each side of abdomen

Palpate fetus between two hands

Assess which side is spine and which extremities

o Third Maneuver (Lower pole)

Examiner faces woman's feet

Palpate just above symphysis pubis

Palpate fetal presenting part between two hands

Assess for Fetal Descent

o Fourth Maneuver (Presenting part evaluation)

Examiner faces woman's head

Apply downward prEssure on uterine fundus

Hold presenting part between index finger and thumb

Assess for cephalic versus Breech Presentation

(A) The uterine fundus is palpated to determine which fetal part occupies the fundus. (B) Each

side of the maternal abdomen is palpated to determine which side is fetal spine and which is the

extremities. (C) The area above the symphysis pubis is palpated to locate the fetal presenting

part and thus determine how far the fetus has descended and whether the fetus is engaged. (D)

One hand applies pressure on the fundus while the index finger and thumb of the other hand

palpate the presenting part to confirm presentation and engagement.

Auscultation – use pinard stetescope at fetal shoulder or can use hand-helad Doppler device.

What to comment?????

Focus areas for abdominal palpation

o Assess Fundal Height Fundal height (cm) approximates weeks of gestation

o Assess Fetal Lie

Longitudinal (Normal)

Transverse

Oblique

o Assess Fetal Presentation

Breech Presentation

Cephalic Presentation

Vertex Presentation (Normal attitude: Full flexion)

Face Presentation (Abnormal attitude: Head extends)

o Assess Fetal Vertex Position

Left Occiput Lateral (LOL) 40%

Left Occiput Anterior (LOA) 12%

Left Occiput Posterior (LOP) 3%

Right Occiput Lateral (ROL) 25%

Right Occiput Anterior (ROA) 10%

Right Occiput Posterior (ROP) 10%

o Assess Fetal Descent

Is Vertex engaged?

Other methods of determining Fetal Orientation

o Obstetric Ultrasound

o Digital cervical exam