Exame Físico Obstétrico: manobras de palpação uterina e ausculta fetal

Summary

The script provides a detailed explanation of obstetric palpation techniques used to assess the baby's position, presentation, and amount of amniotic fluid during pregnancy. It covers the Leopold maneuvers, describing how to identify the fetal parts, such as the head or buttocks, and how to assess fetal movement and the condition of the pregnancy. The importance of monitoring fetal heart rate using Doppler or Pinard stethoscope after 12 weeks is emphasized, as well as how the practitioner's physical examination can foster a connection between the pregnant person, their family, and the healthcare provider.

Takeaways

• 😀 Physical examination of the pregnant woman includes Leopold's maneuvers to assess the baby's position, presentation, and amniotic fluid level.
• 😀 Leopold's maneuvers help determine if the baby is in a longitudinal or transverse position and whether the presentation is cephalic or breech.
• 😀 The palpation technique is essential from the third trimester onward to identify the fetal parts, including the head, buttocks, and feet.
• 😀 The head feels firm and well-defined, while the buttocks are larger, softer, and more malleable, making it easier to differentiate between them.
• 😀 The amount of amniotic fluid can be estimated by feeling the tension of the abdomen and locating fluid pockets.
• 😀 Palpation of the fetal poles involves gently moving the fetal part with fingers to identify its position and assess its presentation.
• 😀 The fourth maneuver helps assess fetal descent and engagement by palpating the iliac fossae and pelvis, noting any fetal part that is difficult to reach.
• 😀 It's important to involve the pregnant woman, her partner, and family members in the physical exam to increase their connection with the pregnancy.
• 😀 Asking the pregnant woman to observe fetal movements and discussing when the baby is most active strengthens the emotional bond with the pregnancy.
• 😀 After palpation, the fetal heart rate should be auscultated, and any abnormal findings should be promptly investigated to assess fetal well-being.

Q & A

What is the purpose of Leopold's maneuvers in obstetrics?

Leopold's maneuvers are used to assess the baby's position in the uterus, including its longitudinal or transverse position, cephalic or pelvic presentation, the amount of amniotic fluid, and the height of the presenting part. This helps healthcare professionals monitor fetal well-being.

When is it ideal to begin performing Leopold's maneuvers?

Leopold's maneuvers are generally performed from the third trimester of pregnancy when the fetus is large enough to be palpated and the uterus is more accessible.

What is the difference between palpating the fetal head and the fetal buttocks?

The fetal head is firm and well-defined, while the fetal buttocks feel larger, softer, and more mobile. These differences help healthcare professionals identify the baby's presentation.

How do you assess the amount of amniotic fluid during a physical exam?

The amount of amniotic fluid can be assessed by palpating the abdomen and feeling for the tension of the uterine wall and fluid pockets. This helps estimate whether there is too much or too little amniotic fluid.

What is the significance of the fetal heart rate during the physical exam?

The fetal heart rate is a crucial indicator of fetal well-being. A normal heart rate, typically between 110 and 160 beats per minute, suggests healthy fetal vitality. Abnormalities in the heart rate after uterine contractions or mechanical stimulation could indicate potential concerns.

How is the fetal heart rate measured during the exam?

The fetal heart rate is measured using a Doppler ultrasound (sonar) or a Pinard stethoscope. The healthcare provider listens for the fetal heartbeats, counts them for one minute, and observes the rhythm and frequency.

What should a healthcare provider do if the fetal heart rate is abnormal during the exam?

If the fetal heart rate is abnormal or does not change in response to uterine contractions or mechanical stimulation, it is a sign that further investigation is needed. The provider may need to assess fetal vitality using additional methods or change the maternal position.

Why is it important to ask for the patient’s consent during the exam?

It is essential to ask for the patient’s consent before touching her abdomen or performing any procedures to ensure respect for her autonomy and comfort. Consent also helps in building trust between the healthcare provider and the pregnant person.

What role does the partner or family play during the physical exam?

Involving the partner, family, or other children during the exam can help them understand the process and contribute to bonding with the pregnancy. The healthcare provider can also show them how to identify fetal movements and positions.

What should be done if the patient experiences discomfort or dizziness during the exam?

If the patient experiences discomfort, dizziness, or any signs of hypotension, the provider should change her position to the left lateral decubitus position to improve blood circulation and ensure the safety of both the patient and the fetus.