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) measurement

o Place tape from symphysis pubis to top of fundus, turn the tape to read the
measurement

o 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