An obstetric abdominal examination is performed to monitor fetal growth, assess fetal position, and ensure the well-being of both the mother and the baby.
This exam requires a gentle touch and clear communication to put the mother at ease.
Before beginning, ensure the mother is comfortable and has recently emptied her bladder (this makes the exam easier and more comfortable).
W – Wash: Clean your hands thoroughly.
I – Introduce: State your name and role.
P – Permission & Pain: Obtain consent and ask about any abdominal pain or fetal movements.
E – Exposure: Expose the abdomen from the xiphisternum to the pubic symphysis. Ensure the rest of the body is covered to maintain dignity.
R – (Re)position: The patient should lie supine on the couch with a slight left lateral tilt (using a wedge or pillow) to prevent aortocaval compression (supine hypotensive syndrome).
Observe the gravid abdomen for:
Shape: Is the uterus longitudinal or transverse?
Skin Changes: Look for Linea Nigra (dark vertical line), Striae Gravidarum (stretch marks), or a Pfannenstiel scar (from a previous C-section).
Fetal Movement: You may see the baby moving during the inspection.
Palpation should be systematic, moving from the top of the uterus downward.
1. Fundal Height
Locate the top of the uterus (the fundus) using the ulnar border of your hand. Measure the distance from the symphysis pubis to the fundus in centimeters using a tape measure (turned over so you can’t see the numbers until the end to avoid bias).
Note: After 24 weeks, the symphysis-fundal height (SFH) should roughly correlate to the number of weeks of gestation (e.g., 28 cm ≈ 28 weeks).
2. Lateral Palpation (Leopold’s Manoeuvres)
Place a hand on either side of the uterus to identify the fetal back (a smooth, firm surface) and the fetal limbs (small, irregular “knobby” parts). This helps determine the fetal lie (longitudinal, transverse, or oblique).
3. Pelvic Palpation (Presentation)
Facing the patient’s feet, palpate the lower pole of the uterus to determine the presentation:
Cephalic: The head feels hard and round.
Breech: The buttocks feel softer and less regular.
Engagement: Determine how much of the head is felt above the pelvic brim (measured in fifths).
Locate the fetal heart using a Pinard stethoscope or a Handheld Doppler.
The heart is best heard over the foetal shoulder.
Crucial: Simultaneously feel the mother’s radial pulse to ensure you are not accidentally counting her heart rate instead of the baby’s.
Normal Foetal Heart Rate (FHR): 110–160 beats per minute.
To finish your OSCE obstetric assessment, state you would:
Check the Blood Pressure: To screen for pre-eclampsia.
Urinalysis: Check for protein (pre-eclampsia) or glucose (gestational diabetes).
Check for Oedema: Specifically in the legs, hands, and face.
Review the Growth Chart: Plot the SFH on a customized growth chart.
Ultrasound: If there are concerns about growth, liquor volume, or presentation.
| Term | Definition |
| Lie | Relationship between the long axis of the foetus and the mother (e.g. Longitudinal). |
| Presentation | The part of the fetus at the pelvic brim (e.g. Cephalic/Head). |
| Position | Relationship of the presenting part to the maternal pelvis (e.g. Occipito-anterior). |
| Engagement | How far the presenting part has descended into the pelvis (fifths palpable). |
For a visual guide to palpation and Pinard use:
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