How to do Obstetric Examination? Leopold Maneuvers | Obs-Gyne Full Course Launched

Summary

Dr. Shanali Chandra guides viewers through an obstetric examination in this educational video. She emphasizes the importance of patient consent and comfort, explains how to correctly position the patient, and demonstrates how to assess fundal height and fetal position. The video covers techniques like Leopold's maneuvers and the significance of fetal heart sounds in determining the baby's presentation. It concludes with an assessment of a term-sized, relaxed uterus with a cephalic presentation in a left occipital anterior position.

Takeaways

• 👩‍⚕️ Always explain the procedure and obtain verbal consent before starting an obstetric examination.
• 💧 Ensure the patient empties her bladder to avoid misinterpretation of uterine size due to a full bladder.
• 🛌 Position the patient comfortably in dorsal supine position with hips and knees slightly flexed and knees wide apart.
• 🤰 Correct any uterine tilt before palpating for fundal height to ensure accurate assessment.
• 📏 Fundal height is assessed by measuring from the pubic symphysis to the top of the uterus, indicating the stage of pregnancy.
• 📐 Use the ulnar border of the hand to palpate and estimate the fundal height, correlating it with pregnancy weeks.
• 🤰 A term-sized uterus is indicated by full flanks, suggesting the baby's body occupies the space as the head engages.
• 🤲 Perform Leopold's maneuvers to determine the position of the fetus, which includes fundal, lateral, and pelvic grips.
• 👶 The fetal heart rate is best auscultated from the fetal back side, which can indicate the position of the fetus.
• 🔍 The final examination conclusion includes the size of the uterus, presentation (cephalic), and position (left occipital anterior).

Q & A

What is the purpose of the video by Dr. Shanali Chandra?

The purpose of the video is to demonstrate and explain the process of obstetric examination.

Why is it important to empty the bladder before an obstetric examination?

Emptying the bladder is crucial as a full bladder can interfere with the interpretation of the fundal height or the size of the uterus, potentially leading to a falsely high estimation.

What position should the patient be in during the examination?

The patient should be in a dorsal supine position with hips and knees slightly flexed and knees wide apart to relax the abdominal muscles.

Why is it necessary to correct the tilt of the uterus before palpation?

Correcting the tilt of the uterus ensures accurate assessment of the fundal height, as the uterus may be tilted towards one side, affecting the measurement.

How is the fundal height estimated during an obstetric examination?

The fundal height is estimated by palpating from the pubic symphysis to the umbilicus and comparing it to standard measurements corresponding to different weeks of pregnancy.

What does the term 'term-sized uterus' refer to in the context of the examination?

A 'term-sized uterus' refers to a uterus that is at the size expected at full term, typically around 38-40 weeks of pregnancy, with the baby's body occupying the flanks.

What is the significance of Leopold's maneuvers in obstetric examination?

Leopold's maneuvers are a series of four grips used to determine the presentation and position of the fetus, which are crucial for assessing the baby's alignment and potential for a vaginal delivery.

How can the position of the fetal heart sound provide insight into the fetal position?

The position of the fetal heart sound can indicate the position of the fetal back, which helps in determining the fetal presentation and position, such as whether it is anterior or posterior.

What does LOA stand for in the context of fetal position, and how is it determined?

LOA stands for Left Occipito-anterior, which is a term used to describe the position of the fetus where the back of the baby is against the mother's left side and the baby's head is facing towards the mother's front. It is determined by palpation and auscultation of the fetal heart sounds.

Why is it important to auscultate the fetal heart rate during an obstetric examination?

Auscultating the fetal heart rate is important to assess the baby's well-being and to determine the position of the fetal back, which can indicate the fetal presentation and position.

What is the significance of the linea nigra and striagravadorum mentioned in the script?

The linea nigra is a dark line that may appear during pregnancy, running from the navel to the pubic bone, and striagravadorum are stretch marks that can appear on the abdomen. They are significant as they are common physiological changes during pregnancy.

Outlines

00:00

👩‍⚕️ Introduction to Obstetric Examination

Dr. Shanali Chandra introduces the process of obstetric examination. She emphasizes the importance of explaining the procedure to the patient and obtaining verbal consent. Before starting, the patient should empty her bladder to avoid misinterpreting the fundal height. The patient should be positioned comfortably in a dorsal supine position, with knees and hips slightly flexed. Dr. Chandra also highlights the importance of standing on the right side of the patient during the examination and ensuring the uterus is centralized.

05:01

🔍 Inspection Findings and Measurement of Fundal Height

Dr. Chandra explains how to inspect the patient’s abdomen, noting the signs of a longitudinally aligned fetus, central and everted umbilicus, and stretch marks (striae gravidarum). She also points out the linea nigra extending from the umbilicus to the pubic symphysis. After inspecting the abdomen, she demonstrates how to measure the fundal height using anatomical landmarks, dividing the distance between the pubic symphysis and the umbilicus to estimate gestational age. The fundal height is measured at 32 centimeters, indicating a term-sized uterus.

10:11

🩺 Performing Leopold’s Maneuvers

The Leopold’s maneuvers are demonstrated to assess fetal position. Dr. Chandra performs the first three grips while facing the patient, identifying the broad soft part (buttocks), fetal limbs, and fetal back. The fourth pelvic grip reveals that the head has descended deep into the pelvis, indicating engagement. She also explains how to palpate uterine contractions by pressing on the fundus. Throughout the examination, Dr. Chandra emphasizes the importance of detecting the position of the fetal heart to assess fetal wellbeing and determine the position of the fetus (left occipital anterior).

🔊 Auscultating Fetal Heart Sounds

Dr. Chandra concludes the examination by auscultating the fetal heart rate. She describes how the position of the fetal heart sounds shifts as the baby descends deeper into the pelvis. By using landmarks such as the umbilicus and anterior superior iliac spine, she identifies the best location to listen to the fetal heart rate. The fetal heart rate is best heard in the left occipital anterior (LOA) position, confirming the presentation and engagement of the baby. She finishes by using a Doppler to auscultate the fetal heart for a full minute.

📊 Conclusion of Obstetric Examination

Dr. Chandra summarizes the findings of the obstetric examination. The uterus is term-sized and relaxed, with a cephalic presentation in the left occipital anterior (LOA) position. The fetal heart rate is audible and positioned appropriately for a baby in the LOA position. The examination is wrapped up with a brief overview of the results.

Keywords

💡Obstetric Examination

Obstetric Examination refers to the medical assessment of a pregnant woman to monitor the health of the mother and the developing fetus. In the video, Dr. Shanali Chandra demonstrates how to perform an obstetric examination, emphasizing the importance of patient consent, comfort, and proper positioning. The examination includes palpation to assess the fundal height and the position of the fetus, which are crucial for determining the progress and health of the pregnancy.

💡Fundal Height

Fundal height is a measurement of the distance from the pubic bone to the top of the uterus, indicating the size of the uterus and the growth of the fetus. In the script, Dr. Chandra explains how a full bladder can falsely elevate the estimation of fundal height, hence the need for the patient to empty their bladder before the examination. The measurement is used to estimate the gestational age and is a key part of the obstetric examination.

💡Dorsal Supine Position

The Dorsal Supine Position is the posture in which the patient lies on their back with the head and neck aligned with the spine. This position is used during the examination to allow the doctor to access and palpate the abdomen effectively. The video describes how the patient's hips and knees should be slightly flexed and wide apart to relax the abdominal muscles, facilitating a more accurate examination.

💡Text Rotation

Text rotation refers to the lateral tilt of the uterus, which can affect the accuracy of palpation during an obstetric examination. The script mentions that the uterus is often tilted towards the right side, and the doctor should correct this before assessing the fundal height. Correcting text rotation ensures that the measurements and palpation are accurate and not skewed by the natural tilt of the uterus.

💡Leopold's Maneuvers

Leopold's Maneuvers are a series of four techniques used to determine the position of the fetus within the uterus. The video script describes how Dr. Chandra performs these maneuvers to assess the presentation (e.g., cephalic or breech) and the position of the fetus. Each maneuver provides different information about the fetus's orientation, which is vital for planning the delivery.

💡Pelvic Grip

The Pelvic Grip is the fourth of Leopold's Maneuvers, used to determine if the baby's head is engaged (descended into the pelvis). In the script, Dr. Chandra performs the pelvic grip by attempting to place her hands below the presenting part of the fetus. If her hands do not converge, it indicates that the head is deeply engaged in the pelvis, as seen in the video with the term patient.

💡Fetal Heart Rate

Fetal Heart Rate (FHR) is the number of heartbeats per minute of the fetus, which is a critical indicator of fetal health. The video script explains that the FHR is best heard from the fetal back side, and as the head descends into the pelvis, the FHR moves towards the midline and downwards. Dr. Chandra auscultates the FHR to confirm the fetal position and well-being.

💡Auscultation

Auscultation is the medical practice of listening to the internal sounds of the body using a stethoscope to assess health conditions. In the context of the video, Dr. Chandra uses a stethoscope or Doppler to auscultate the fetal heart rate, which helps in determining the fetal position and health. The script describes the best location for auscultation based on the fetal back position.

💡Cephalic Presentation

Cephalic Presentation refers to the fetus presenting with the head first, which is the most common and favorable position for a vaginal delivery. The video script mentions that the patient has a cephalic presentation, indicating that the baby's head is the leading part. This is confirmed through palpation and auscultation during the obstetric examination.

💡LOA Position

LOA stands for Left Occiput Anterior, which describes the specific position of the fetus's head in relation to the mother's pelvis. In the script, Dr. Chandra concludes that the fetus is in a LOA position, meaning the back of the baby's head (occiput) is on the mother's left side and facing anteriorly. This position is favorable for labor and delivery.

Highlights

Introduction to obstetric examination by Dr. Shanali Chandra

Importance of obtaining verbal consent and patient comfort

Explanation of the need to empty the bladder before examination

Positioning the patient for examination with proper exposure and coverage

Correcting uterine tilt before palpation for fundal height assessment

Fundal height assessment and its significance in pregnancy

Using the ulnar border for palpating the fundal height

Measuring symphysis-fundal height in centimeters

Performing Leopold's maneuvers for obstetric grips

Fundal grip to assess the broad and soft parts of the uterus

Lateral grips to identify fetal limbs and back

Polygrip to assess the presenting part of the fetus

Pelvic grip to determine if the fetal head is engaged

Assessing uterine contractions and relaxation

Determining fetal presentation and position through palpation

Auscultation of fetal heart sounds to infer fetal position

Conclusion of the examination indicating term-sized uterus with cephalic presentation

Final assessment of left occipital anterior position using Doppler

Transcripts

[Music]

hello friends hi i'm dr shanali chandra

and i welcome you all to our youtube

channel medicine decoded now in this

small video i'm going to show you

obstetric examination now before you

examine a patient make sure that you

explain to the patient what you're going

to do all right so take a

verbal consent and at the same time you

know make the patient lie down for

examination after she passes urine right

so ask her to empty the bladder because

you see full bladder will interfere with

your interpretation of the fundal height

or the size of the uterus because uh if

the bladder is full it pushes the uterus

upwards then you might get a falsely a

high falsely high estimation of bundle

height now make the patient feel

comfortable be comfortable while she is

being examined

and also yes while you're positioning

the patient keep in mind that you are

going to examine the patient standing on

the right side of the patient and the

abdomen is exposed fully right from the

pubic surfaces to the suture sternum

this entire area and the rest of the

area should be properly covered you know

and uh patient is in the dorsal supine

position

like this right so the patient's head is

on this side feet are on this side i'm

standing to the right side of the

patient okay and the hips and the knees

are slightly flexed here and the knees

are wide apart uh that allows for the

relaxation of the abdominal muscle now

also keep in mind that sometimes the

uterus may be tilted towards one side or

the other side okay so most of the times

it is tilted towards the right side like

this texture rotate it so before you

start palpating for the fundal height

assessment make sure that you correct

this tilt you correct the text to

rotation and standing on the right side

of the patient you can you know tilt the

uterus like this stabilize it like this

and then go on to estimate the fundal

height so keep this in mind here one

more important point before palpation

centralize the uterus

now in this video the patient that i'm

performing the obstetric examination on

is a term patient

so let us begin

the patient is in dorsal supine position

with knees and hips flexed and knees

wide apart so describing the inspection

findings this is the pubic symphysis and

look at the avoid bulge seems the fetus

is longitudinally aligned

and you can see the umbilicus is central

and everted

and you can see these uh striagravidarum

which are the stretch marks

and

you can also see this deep line of

pigmentation you see extending from the

umbilicus to the pubic symphysis

and this is called as the linear [ __ ]

and these are the striagravaderum

and you can see that the overlying skin

is healthy there is no scar mark of any

kind indicating of any previous surgery

now for palpation

from symphysis pubis to umbilicus we

divide into two equal parts

if fundus is here midway between the

umbilicus and pubic symphysis bundle

height is 16 weeks

if the fundus is at umblicus then the

fundal height is 24 weeks now this is

iffy sternum

from zifi standard to umbilicus we

divide into three equal parts till here

it is 28 weeks till here 32 weeks and

all the way up to zifistandam it's 36

weeks

now to see the fundal height we start

palpating from the zifi star numb

using the ulnar border of our hand and

see where we feel the fundus

so this is 32 weeks but the patient is

term

why so because the flanks are full bulk

of the baby is in the flags

when the head goes down to the pelvis

flanks are occupied by the baby's body

so this is 32 weeks with flanks full

so this is a term size uterus

and now let us mark the fundal height by

using a pen

so

now to measure the simphiso fundal

height in centimeters we will have to

ask the woman to straighten her legs

first

so

let's ask her to straighten the legs and

we take the inch tape here

now the centimeter side should be away

from our vision and the inches side

should be facing you

so this is the pubic symphysis fubis

here and i place the inch tape here

and then take it up to the mark which i

had put

right so the inches is towards me and i

turn it over this is 32 this is 32

centimeters

so 32 centimeters is our symphysia

fundal height in centimeters and with

flanks full

okay

let's see it again

measuring the simphiso fundal height

see the centimeters

side is away from your vision this is 32

centimeters simplifies to fundal height

with flanks full so this is a term size

uterus

now we have to do the leupold's

maneuvers

the obstetric grips

for that you have to ask the woman to

flex her knees and hips again

with the knees wide apart and that

relaxes the abdominal muscles now the

first three grips are done facing the

patient

so checking the fundal grip now i am

palpating broad soft part like the

buttocks and then for the lateral grips

you stabilize with one hand on one side

and then do the grip on the other side

like i am here palpating the right side

of the mother so this is the right

lateral grip you look more closely

here i am

feeling knobby parts on the right side

of the mother suggestive of fetal limbs

and on the left side i'm feeling a

curved part which is suggestive of the

fetal back side now for the third grip

that is the polygrip we use one hand we

use one hand to grasp the presenting

part now if the head is free it is

blottable

but here the head is not free

now for the fourth grip which is the

pelvic grip right we face the patient's

legs okay

and we take the two hands and try to dig

here

you know below the presenting part we

try to go beneath the presenting part

with both our hands parallel to the

inguinal ligament as you can see okay

but my two hands are not converging

below the presenting part right that

means that the head has gone deep into

the pelvis okay that means that the head

is most likely engaged now let us

palpate the contractions okay now for

that you have to place one hand on the

woman's fundus here and then feel

feel the uterus

so like here the uterus is relaxed

because i'm able to indent the uterine

wall with gentle pressure by my fingers

here

but when the uterus is contracted and

this hardening of the uterus this

indentation of the wall of the uterus

will not be possible

okay and the woman will complain of pain

so what did we see

here are the buttocks

head is here

back is here on left side

limbs here on right side so longitudinal

like a phallic presentation back on the

left side so occiput is also on the left

side so this is left occipital position

it could be transverse or anterior left

occipital transfer or left occipital

anterior we don't know as of right now

in the confirmation of loa or lot or for

that matter occiput or posterior

position will eventually be done by the

pv examination but the position of the

fetal heart sound where the fetal heart

sound is heard with maximum intensity

will give us a very good idea about the

position in

anterior position fetal heart rate is

best heard anteriorly in occipital

posterior position fetal heart rate is

best heard at the flanks should i

auscultate here no i will auscultate

here because fetal heart sounds are best

heard transmitted from the fetal back

side so in this case on the left side

so where exactly should be auscultated

now this is the umbilicus and this is

the anterior square ilex spine now

between these two points let us imagine

a spino um like a line and midpoint here

of this line

here is where one should auscultate for

the fetal heart sound so let me

auscultate here

now as the head goes down into the

pelvis you see the fetal heart rate also

moves towards the midline and downwards

now i can hear it here best

this means the head has gone down deep

into the pelvis and it is loa position

left occipital anterior

now let us here with doppler and

auscultate for full one minute

and remember as the head goes down deep

into the pelvis the fetal heart rate

moves more towards the center and

downwards so at the end of this

examination we can conclude that this is

a term-sized relaxed uterus with

cephalic presentation in loa position

left occipital anterior position

[Music]

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