1059_obstetric_examination (1).pdf

OBSTETRIC EXAMINATION Dr Rakhi gaur  PRIOR TO EXAMINATION Need a warm and private environment. Check patients ID, consider the need for a Chaperone (Screen) Wash your hands (preferably ensuring they are warm) Introduce yourself and say what status you hol...

OBSTETRIC EXAMINATION Dr Rakhi gaur  PRIOR TO EXAMINATION Need a warm and private environment. Check patients ID, consider the need for a Chaperone (Screen) Wash your hands (preferably ensuring they are warm) Introduce yourself and say what status you hold Explain why you need to palpate the patient’s abdomen Gain verbal consent Ensure the patient has emptied her bladder to avoid discomfort Position patient appropriately – supine -head and top of shoulders only supported by pillow - hands by side. (Be aware of supine hypotensive syndrome)  Back to Basics ….. ▪Inspect – ▪ Inspect the abdomen (shape, size, scars, linea nigra, striae, movements, colour) ▪Palpate - ▪Abdomen for - growth (gestational age estimated by fundal height measurement) , movements, Fetal parts, No. of fetus, lie, position, presentation and engagement. ▪Auscultate – ▪Abdomen for Fetal Heat Rate. Use fetal stethoscope - pinard  Palpation Maintain your patient’s dignity at all times Expose only as much of your patient as is required. Ensure that your patient is positioned appropriately and that you have warm hands. Palpate the abdomen using even movements of the flat of the palmar surface of closed fingers. (Aim to maintain hand to skin contact as much as possible rather than taking hands on and off the surface of the abdomen). Do not prod the abdomen or use jerky movements as these are likely to irritate the uterus and stimulate a contraction. -Use even movements of the flat of the palmar surface of closed fingers. -Aim to maintain hand to skin contact as much as possible. -Do not prod the abdomen or use jerky movements as these are likely to irritate the uterus and stimulate a contraction. Points to record Inspection The Fundal Height Accurate palpation requires practice and experience. The Lie The Presentation The Position Engagement Fetal Heart Rate Uncertain or abnormal findings on This might help you to remember – palpation may need to be I F LI P P E R investigated /confirmed other means, e.g.. Ultrasound scan.  The fundal height The woman lies supine. Palpate for the fundus first. The fundus is not usually palpated abdominally before 12 weeks gestation. Apply gentle pressure with the flat palmar surface of your hand moving downwards from the xiphisternum - to palpate the top of the fundus. The fundal height can be measured in Cm. Place the zero end of the tape measure at the fundus.  Measurement of fundal height Zero of the tape measure is held at the fundus. Gently stretch the tape measure over the abdomen to the superior border of the symphysis pubis. Look on the reverse of the tape, and document the measurement in centimeters.  Palpation- identifying the LIE The palpation continues down the body of the uterus. The smooth back of the fetus is palpated and identified (the lie). The irregular surface created by the limbs, hands and feet is identified.  Palpation- identifying the PRESENTATION ▪ The uterus is gently palpated between the palms of two hands. ▪ The fetal part in the upper pole (in this case the breech) and the lower pole of the uterus are identified. ▪ Characteristically the breech is softer than the head, there is no angle formed by the neck and the surface continues smoothly with the back.  Position The position of the foetus is described by the relationship of the presenting part to the maternal pelvis The denominator for the presenting part for a Cephalic presentation = occiput and for a Breech presentation = sacrum Assessing the fetal heart rate 1 The Fetal Heart (FH) should be auscultated using a fetal stethoscope known either as – Pinnard ( a wood metal or plastic device) – or a sonicaid (an electronic device) The chosen device is placed over the baby’s back (the nearer the shoulder the clearer the FH can be heard) Location of the fetal heart may help to confirm your findings on palpation. Assessing the fetal heart rate 2 The fetal heart rate should be counted for a full minute while also palpating the mother’s pulse (allows the examiner to differentiate between maternal and fetal heart rate). A normal fetal heart rate is between 110 – 160 beats per minute (mother’s pulse should be counted separately).  PRESENTING and RECORDING Your findings 1.REPORT - observation / inspection 2. Fundal height in CMS = …… 3.The Lie is ….. 4.The Presentation is …… 5.The Position is …… 6. Engagement ? 7. Fetal Heart (FH) is …… 8. Other ??? OBSTETRICAL GRIPS