docAims of obstetric examination
download 
Report Transcription
Aims of obstetric examination
OBSTETRIC EXAMINATION Dr Japaraj HRPB Ipoh Aims of obstetric examination • To come to a reasonable diagnosis or differential diagnosis • Confirm diagnosis • Progress of labour • Assess size of baby • Importance of correlating examination with history Aims of obstetric examination • Abdominal – Size of uterus – Size of fetus – Lie – Presentation – Engagement – Fetal viability Aims of obstetric examination • Vaginal examination – Speculum • • • • Miscarriage Leaking Discharge Tumor / ulceration – Digital • Size of uterus • Adnexal mass • Progress of labour History • Full medical History • Obstetric History • Family History • Pregnancy Risk Factors Preparation • • • • • • Clean your hands Consent Explain your actions Privacy Chaperone Equipment 1st and early 2nd trimester • Abdominal examination – Abdominal mass – Abdominal tenderness 1st and early 2nd trimester • Vaginal examination – Speculum examination – Bimanual digital examination • Uterus – Size – Anteverted or retroverted – Mobility • Adnexal mass • Cervical excitation 1st and early 2nd trimester Late 2nd and 3rd trimester • General examination • Abdominal examination – Inspection – Palpation – Auscultation Abdominal examination Inspection • Skin • Scars • Umbilicus • Fetal movement Abdominal examination Palpation • Superficial palpation – Tenderness • Symphysio-fundal height measurement • Leopold’s maneuvers Symphysio-fundal Height • Palpate uterus with left hand • To find fundus press, there is a ‘give’ at the fundus • Measure from here with a straight tape down to the pubic symphysis Leopold’s maneuvers • Fundal grip – Poles • Lateral grip – Lie • Pelvic grip – Presentation Fetal Poles & axis • The fetal poles refer to the head and bottom of the fetus. • In Twins at least three fetal poles should be felt. • From finding the 2 poles you can determine the ‘lie/axis’ of the baby e.g. longitudinal, transverse or oblique. Axis Presentation • Turn to face the pelvis and press the fingers of both hands firmly downwards just above the symphysis pubis • Head= cephalic • Bottom=Breech • Any other part of the body=compact presentation e.g. shoulder, arm. Head engagement • Ballot head between fingers • Record in fifths palpable • Head engaged at 2/5 palpable or less • Free at 3/5 palpable or more Auscultation with the Pinard Stethoscope • Place funnel end over the left anterior shoulder of the fetus and press ear to other end • Difficult technique / skill • Should always be done prior to using sonic-aid Examination during labour Aim • Time contractions • Status of fetus • • • • Presentation Lie Size Engagement • Stage of labour • Progress of labour Stage of labour Vaginal examination • Vulva/vagina • Cervix – Length – Position – Consistency • • • • • • • Os Station Presentation Membrane Liquor Position of fetus Any other things felt – Cord – Fetal vessels (Vasa previa) Examination post delivery Immediate post delivery • Abdominal examination – Size of uterus – Contraction of uterus • Vaginal examination – Amount of bleeding – Perineum tears/laceration – Cervix – Os Examination post delivery Late post delivery • Abdominal examination – Involution of the uterus – Healing of scar • Others – DVT – Breast THANK YOU
