How to do Obstetric Examination? Leopold Maneuvers | Obs-Gyne Full Course Launched
Summary
TLDRDr. 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
- π©ββοΈ Always explain the procedure and obtain verbal consent before starting an obstetric examination.
- π§ Ensure the patient empties her bladder to avoid misinterpretation of uterine size due to a full bladder.
- π Position the patient comfortably in dorsal supine position with hips and knees slightly flexed and knees wide apart.
- π€° Correct any uterine tilt before palpating for fundal height to ensure accurate assessment.
- π Fundal height is assessed by measuring from the pubic symphysis to the top of the uterus, indicating the stage of pregnancy.
- π Use the ulnar border of the hand to palpate and estimate the fundal height, correlating it with pregnancy weeks.
- π€° A term-sized uterus is indicated by full flanks, suggesting the baby's body occupies the space as the head engages.
- π€² Perform Leopold's maneuvers to determine the position of the fetus, which includes fundal, lateral, and pelvic grips.
- πΆ The fetal heart rate is best auscultated from the fetal back side, which can indicate the position of the fetus.
- π 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
π©ββοΈ 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.
π Inspection Findings and Measurement of Fundal Height
Dr. Chandra explains how to inspect the patientβs 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.
π©Ί Performing Leopoldβs Maneuvers
The Leopoldβs 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).
π 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.
π 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.
Mindmap
Keywords
π‘Obstetric Examination
π‘Fundal Height
π‘Dorsal Supine Position
π‘Text Rotation
π‘Leopold's Maneuvers
π‘Pelvic Grip
π‘Fetal Heart Rate
π‘Auscultation
π‘Cephalic Presentation
π‘LOA Position
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 [Β __Β ]
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]
you
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