Admitting OB IE

Wednesday, January 21, 2009

6:09 PM
Fetal Lie - Relation of the long axis of the fetus with the long axis of the mother. This can be:
• Longitudinal (when it is parallel)
• Transverse (when it is perpendicular)
• Oblique (temporary)

Leopold's Maneuvers

L1 - Fundal grip. This is to identify the fetal pole occupying the fundus.
L2 - Umbilical grip - Identify the fetal back and small parts in relation to the mother's.
L3 - Engagement. Look for the presenting part. Use your thumb and index fingers.
L4 - Confirms L1-L3. Find which hand gets arrested first. It is stopped by the cephalic prominence. Gives you an idea of the attitude of the head. If fetal
small parts are the same as the cephalic prominence -> vertex position. If cephalic prominence is at the same side as the back -> face presentation.
After this, note the fetal heart tone, then note for the contractions (duration, intervals, intensity).

Pelvic Examination:
• Adequacy of the pelvis (clinical pelvimetry not that accurate).
 Can depend on the size of the fetus.
• Cervical dilatation
• Effacement - thinning out of the cervix
• Presenting part
 Cephalic part
 Breech
 Shoulder
 Fetal position - the relationship of an arbitrarily chosen part in relation to the mother.
□ Vertex
 Landmark is the posterior fontanel (occiput) which is triangular. The anterior fontanel is the synciput

□ Breech and Leg

 Landmark is the sacrum.
□ Face
 Landmark is the chin.
 Engagement - the biparietal diameter has gone below the pelvic inlet (ischial spines)
 Station - how far the presenting part has gone down.
□ If at base of ischial spine = Level 0
□ If at pelvic floor = +3

Cervical Dilatation
Two things to do:
• Locate the cervix - shape like a mound and there is an OS.
• Dilatation measurement - if internal and external OS is open.
Technique:
• Know your base (mine's 2.5-3cm)
Example:
10cm - cervix is no longer existent.
9 cm - if something is still there.
8 - if cervical lip is >0.5cm, if lesser then 9.

Pelvimetry
• Assess the pelvis if it can accommodate the fetus.
• The pelvic inlet is bounded by the:
 Promontory
 Iliac spine
 Pubis symphysis
• The pelvic inlet cannot be measured directly, but the pelvic outlet can be directly measured.
• Pelvic inlet measurement:
 Diagonal Conjugate
□ Insert two fingers of the dominant hand -> assess mobility of the coccyx -> palpate towards the sacrum (usually you can palpate up to
the lower 3 sacral vertebra) -> flex elbow and palpate upwards to the sacral promontory -> move hand upward so as to form a
diagonal line from the promontory to the symphysis pubis. Measure. -> Diagonal conjugate. (>11.5cm is adequate)
□ Obstetric inlet = measured diagonal conjugate - 1.5 to 2.0cm
 Engagement

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