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The Patient

  • General Features

    Age, general comfort

  • Body Habitus

    Weight (change), BMI

  • Bruising

  • Oedema

    Of the face / arms / legs

The Abdomen - Inspection

  • Abdominal Size

  • Scars

    Pfannenstiel, other past surgery

  • Skin

    Linea nigra, striae gravidarum, striae albicans

  • Foetal Movement

    Normally visible after 24 weeks

The Abdomen - Palpation

  • Tenderness

    Palpate each segment of the abdomen

  • Symphysis-Fundal Height

    Palpate down from xiphisternum to fundus, measure from fundus to symphysis pubis

  • Leopold's Manoeuvre 1: Fundal Grip

    Foetal poles

    Place both hands over the fundus

  • Leopold's Manoeuvre 2: Lateral Grip

    Foetal lie

    Move hands downward along sides of uterus

  • Leopold's Manoeuvre 3: Pawlik's Grip

    Foetal presentation

    Firmly grip presenting part between thumb & index finger

  • Leopold's Manoeuvre 3: Deep Pelvic Grip

    Hands facing downward, feel for foetal head

  • Myometrium

    Soft / hard / contracting

  • Liquor Volume

    Foetal parts subjectively easy or difficult to feel

  • Foetal Movement

The Abdomen - Auscultation

  • Foetal Heart

    Using Pinard's stethoscope or hand-held Doppler

Vaginal Examination in Labour

  • Prepare

    Consent, chaperone, undress, position

  • Cervical Dilatation

    Using index finger breadth

    1 finger = 1-1.5cm

  • Cervical Length

    Shortens during labour

    Normal 3-3.5cm

  • Consistency

    Soft / medium / firm

  • Cervical Position

    Anterior / posterior

  • Station

    Level of presenting part compared to ischial spines

  • Foetal Head

    Identify anterior fontanelle (diamond) and posterior fontanelle (triangle)

    Occiput-anterior (OA) / -posterior (OP) / -lateral (OL)

  • Liquor

    Membranes intact / ruptured, meconium liquor

Snapshot: Initialising...