Examination of an obstetric patient.

Summary

This video provides a detailed guide on conducting an abdominal examination of an obstetric patient. It covers essential steps, including ensuring patient comfort, obtaining consent, and proper exposure. The examination involves inspection for signs like abdominal distension, umbilical position, and scars. Palpation of uterine and symphysial heights helps assess gestational age. The script also explains the four grip maneuvers to identify fetal position and the descent of the presenting part. Lastly, auscultating the fetal heart rate offers insights into the fetus's well-being, all crucial for a thorough prenatal assessment.

Takeaways

• 😀 Ensure the patient has passed urine and obtained consent before beginning the examination.
• 😀 Expose the abdomen from the xiphoid sternum to the pubic symphysis for a thorough inspection.
• 😀 Inspect the abdomen for signs of distension, gravidity, umbilicus position, and any previous surgical scars, such as a cesarean section scar.
• 😀 Ask the patient to flex her legs before proceeding with palpation for a more comfortable and accurate examination.
• 😀 Use the left hand to palpate from the xiphoid sternum to assess the uterine height and estimate the gestational age based on resistance felt.
• 😀 Measure the symphysis-fundal height using a measuring tape from the fundus to the pubic symphysis, which should correlate with gestational age (±3 cm).
• 😀 Perform the four grips of palpation: fundal grip, lateral grip, first pelvic grip, and second pelvic grip, to assess fetal position and presentation.
• 😀 Fundal grip helps determine whether the presenting part is the head or breech.
• 😀 Lateral grip helps identify the location of the back and limbs of the fetus.
• 😀 Auscultate the fetal heart rate on the side of the back to assess the well-being of the fetus.

Q & A

What is the first step in examining an obstetric patient’s abdomen?

The first step is to ensure that the patient has passed urine, obtained consent, explained the procedure to her, and exposed the abdomen from the synthetic sternum to the pubic symphysis.

What can be observed during the inspection of the abdomen?

During the inspection, the abdomen may appear distended with gravitas, the umbilicus is typically central and inverted, and there might be signs of previous surgical procedures, such as a cesarean section scar.

What is the significance of the patient flexing her legs during the abdominal examination?

Flexing the patient's legs helps to relax the abdominal muscles, making it easier to palpate the uterus and assess other relevant abdominal features.

How is uterine height measured during palpation?

Uterine height is assessed by using the ulnar border of the left hand to palpate from the xiphoid sternum down to where resistance is felt. The point of resistance corresponds to the fundal height, which reflects the gestational age.

What does a uterine height of 32 weeks gestation indicate?

A uterine height corresponding to 32 weeks gestation indicates that the uterus has grown to a size that matches the expected gestational age, based on the resistance felt during palpation.

How is the symphysis-fundus height measured?

The symphysis-fundus height is measured using a measuring tape from the fundus (where resistance is palpated) to the pubic symphysis, typically measured in centimeters.

What is the expected correlation between fundal height and gestational age?

The fundal height should typically correlate with the gestational age, within a range of ±3 centimeters between 20 and 36 weeks of gestation.

What are the four grips used in the abdominal examination, and what do they assess?

The four grips are: 1) Fundal grip, to determine if the presenting part is the breech or head; 2) Lateral grips, to locate the back and limbs; 3) First pelvic grip, to assess the lower pole of the uterus; 4) Second pelvic grip, to check if the presenting part has entered the pelvis.

What does the second pelvic grip reveal about the presenting part?

The second pelvic grip helps determine if the presenting part has entered the pelvis by checking if the hands converge or diverge when placed near the pelvic inlet.

Why is auscultation of the fetal heart rate important in obstetric examination?

Auscultating the fetal heart rate on the side of the back allows the examiner to assess fetal well-being and ensure the fetal heart is heard clearly, providing vital information on the baby's condition.