Obstetric abdominal examination frequently appears in OSCEs and you’ll be expected to pick up the relevant clinical signs using your examination skills. This obstetric abdominal examination OSCE guide provides a clear step-by-step approach to examining the pregnant abdomen, with an included video demonstration. Show
Download the obstetric abdominal examination PDF OSCE checklist, or use our interactive OSCE checklist. Gather equipmentGather relevant equipment including:
You might also be interested in our OSCE Flashcard Collection which contains over 2000 flashcards that cover clinical examination, procedures, communication skills and data interpretation. IntroductionWash your hands and don PPE if appropriate. Introduce yourself to the patient including your name and role. Confirm the patient’s name and date of birth. Briefly explain what the examination will involve using patient-friendly language: “Today I need to examine your tummy as part of the assessment of your pregnancy. This will involve me looking and feeling the tummy, in addition to performing some measurements. Although it may be a little uncomfortable, it shouldn’t be painful. If at any point you’d like me to stop then please just let me know.” Gain consent to proceed with the examination: “Do you understand everything I’ve said? Are you happy for me to carry out the examination?” Position the patient on the clinical examination couch with the head of the bed at a 30-45° angle for the initial assessment. Adequately expose the patient’s abdomen for the examination from the pubic symphysis to the xiphisternum (offer a blanket to allow exposure only when required). Provide the patient with the opportunity to pass urine before the examination. Ask the patient if they have any pain before proceeding with the clinical examination. General inspectionClinical signsInspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology:
Objects and equipmentLook for objects or equipment on or around the patient that may provide useful insights into their medical history and current clinical status:
Obstetric cholestasisObstetric cholestasis is a multifactorial condition that is characterised by abnormal liver function tests, jaundice and intense pruritis (typically affecting the palms and soles of the feet). The disease usually presents in the third trimester and is associated with an increased risk of intrauterine death and premature delivery. HandsThe hands can provide lots of clinically relevant information and therefore a focused, structured assessment is essential. Inspect the hands for relevant clinical signs:
TemperaturePlace the dorsal aspect of your hand onto the patient’s to assess temperature:
Capillary refill time (CRT)Measuring capillary refill time (CRT) in the hands is a useful way of assessing peripheral perfusion:
Radial pulsePalpate the patient’s radial pulse, located at the radial side of the wrist, with the tips of your index and middle fingers aligned longitudinally over the course of the artery. Once you have located the radial pulse, assess the rate and rhythm. Heart rateAssessing heart rate:
FaceInspect the patient’s face for relevant clinical signs:
Abdominal inspectionPosition the patientThe recommended positioning for a patient during pregnancy varies, depending on the current gestation:
Closely inspect the abdomenExpose the abdomen appropriately, from the xiphisternum to the pubic symphysis and inspect for relevant clinical signs:
Aortocaval compression syndromeAortocaval compression syndrome occurs due to compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman is supine. Aortocaval compression can result in maternal hypotension, loss of consciousness and in rare cases fetal demise. Women in late pregnancy are positioned in the left lateral position when supine to reduce pressure on the aorta and inferior vena cava. Abdominal palpationAsk about abdominal tenderness before palpating the abdomen and continue to monitor the patient’s face for signs of discomfort throughout the examination. Palpate the abdomenBriefly perform light palpation over each of the nine regions of the abdomen to identify any tenderness or masses that may not relate to the pregnancy (e.g. appendicitis). See the abdominal examination guide for more details. Palpate the uterusPalpate the uterus to identify its borders, including the upper and lateral edges. The uterine fundus can be found at different locations during pregnancy, depending on the patient’s current gestation:
Fetal lieFetal lie refers to the relationship between the long axis of the fetus with respect to the long axis of the mother. Assess the gravid uterus to determine the fetal lie: 1. Place your hands on either side of the patient’s uterus (ensuring you are facing the patient). 2. Gently palpate each side of the uterus:
Types of fetal lieThere are three main types of fetal lie which include:
Fetal presentationFetal presentation refers to which anatomical part of the fetus is closest to the pelvic inlet. Assess the gravid uterus to determine fetal presentation: 1. Ensure you are facing the patient to observe for signs of discomfort and warn the patient this may feel a little uncomfortable. 2. Place your hands either side of the lower pole of the uterus, just above the pubic symphysis. 3. Apply firm pressure to the uterus angled medially, palpating for the presenting part:
Fetal engagementIn late pregnancy, the level of fetal engagement should be assessed. A fetus is considered ‘engaged’ when more than 50% of the presenting part (usually the head) has descended into the pelvis. The fetal head is divided into fifths when assessing engagement:
Symphyseal-fundal heightSymphyseal-fundal height is the distance between the fundus and the upper border of the pubic symphysis. After 20 weeks gestation, the symphyseal-fundal height should correlate with the gestational age of the fetus in weeks (+/- 2cm). To measure the symphyseal-fundal height: 1. Begin palpation of the abdomen just inferior to the xiphisternum using the ulnar border of your left hand. 2. Locate the fundus of the uterus (a firm feeling edge at the upper border of the bump). 3. Once the fundus has been identified, locate the upper border of the pubic symphysis. 4. Measure the distance between the upper uterine border and the pubic symphysis in centimetres using a tape measure. The distance measured should correlate with the gestational age in weeks (+/- 2cm). To avoid bias, it’s best to place the tape measure facing down and only turn to view the numbers once in position. Fetal heartbeatYou may be asked to identify the fetal heartbeat using a Pinard stethoscope (or a Doppler ultrasound probe). As a result, it is important to have a basic understanding of how to locate and identify the fetal heartbeat. 1. Based on your assessment of the fetus’s position, you should place the Pinard stethoscope aiming between the fetal shoulders on the fetal back. 2. Palpate the patient’s radial pulse (i.e. maternal pulse). 3. Place your ear to the Pinard and take your hand away (so the Pinard is held against the abdomen using your ear only):
4. Listen for the fetal heartbeat:
To complete the examination…Explain to the patient that the examination is now finished. Thank the patient for their time. Dispose of PPE appropriately and wash your hands. Summarise your findings. Example summary“Today I examined Mrs Smith, a 28-year-old female who is currently at 36 weeks gestation. On general inspection, the patient appeared comfortable at rest. There were no objects or medical equipment around the bed of relevance. There was no evidence of oedema of the face or peripheries on assessment.” “Symphyseal-fundal height was 36cm, which is in keeping with the patient’s current gestation. The fetus was positioned in a longitudinal lie with a cephalic presentation. The fetal head was three fifths palpable.” “In summary, these findings are consistent with a normal obstetric abdominal examination.” “For completeness, I would like to perform the following further assessments and investigations.” Further assessments and investigations
ReviewersMr Isaac MaganiConsultant Obstetrician Mr Gareth WaringSenior Obstetric Registrar IllustratorAisha AliMedical Student and Illustrator References
Where is the best place to palpate a pulse in this infant?Taking an Infant's Pulse
Feel for the pulse on the inner arm between the shoulder and the elbow: Gently press two fingers (don't use your thumb) on the spot until you feel a beat. When you feel the pulse, count the beats for 15 seconds. Multiply the number of beats you counted by 4 to get the beats per minute.
Where is the location in checking pulse for infant victims?Check the pulse in the infant using the brachial artery on the inside of the upper arm between the infant's elbow and shoulder.
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