Obstetric Examination Checklist

Obstetric Abdominal Examination Checklist

What should we do when we have a pregnant lady that needs physical examination?

The checklist below is a guidance to what you must do to make sure both the mum and baby are healthy and safe.😌

However every hospital have a different checklist, you need to make sure you do what the professor is expecting you to do. 

In all Physical Examination checklist there must be 5 aspects be done from

1. Introduction and consent

2. Inspection

3. Palpation

4. Auscultation

5. Presentation

If you panic during the exam, always think of this 4 aspects, and you will remember what you need to do.

Introduction

• Introduce yourself 
• Explain why are you here (to examine her and her baby's well being)
• Ask the patient to get ready. eg: to have proper exposure of her tummy and lie on her back facing upwards.
• Wash your hands and prepare instruments needed for the checkup

Inspection checklist

• Abdominal distension (is it normal distension or abnormal)
• Shape of uterus
• Scar / Linea nigrae/ Striae
• take note of the surgical scar (can be from C-section)
• Is it healed? or keloid form?
• Any fetal movements visible?

Palpation

• Superficial
• Tenderness?
• Fetal movements
• SFH - symphysis fundal height 
• Important to determine if there are any abnormalities, eg. :
• Big: multiple pregnancy, growth restriction, polyhydramious
• Small: FGR, oligohydramious
• Fundal grip
• Lateral grip
• Pelvic grip

• Fetal Lie
• transverse? longitudinal? or oblique?

• Palpate the fetus size softly to determine his position by checking:
• upper pole - is it round? soft?
• lower pole - hard? globular?
• Left side - soft broad curved structure? (back)
• Right side - Irregular structure? (limbs)

• Confirm any head engagement
• Are there adequate liquor 

Auscultation

• check fetal heart rate using fetoscope

Presentation - what to explain

Step 1

• Uterine contraction presence
• Uterus correspond to date
• Any breech? and explain

• type of lie, usually longitudinal.
• cephalic presentation?
• head engagement?
• adequate liquor ?

 For example: The fetal lie was longitudinal with a cephalic presentation noted to be 4/5th palpable on abdominal examination.

Step 2

• present SFH eg. the measurements

Step 3

• Fetal HR
• surgical scar 
• EFW
• Liquor volume

Step 4

• Gather information about delivery history
• successful vaginal delivery? c-section? what are the indications/ complications? weight of the previous baby.
• Suggest further assessment
• ultrasound to confirm location
• cardiotocogram - exclude fetal compromise
• vaginal examination
• give appropriate counsel
• eg: on VBAC benefits, success, complication compare to LSCS
• reassure patient and thank them. 

A video to help you understand better:
https://www.youtube.com/watch?v=-pkkgBX7OFQ