5. Obstetric examination - Leopold maneuvers, measurements, auscultation. Fetal attitude, lie, presentation and position
Explains the obstetric examination of the fetus through the four Leopold manoeuvres, with a table of what each hand position reveals about the fundus, back, presenting part and engagement. Covers the Latin terms for attitude, lie, presentation and position, including the denominator used to name the position, such as left occipito-anterior. Also outlines the main measurements taken during pregnancy and how the fetal heart is auscultated, with its normal rate and how to tell it from the maternal pulse.
Topic 5 of 61 in the MU Sofia syllabus for Obstetrics and Gynaecology (Dental Medicine, Year 4). The free AceMed note covers it in 5 sections, about 172 words (2 min of reading), with 16 flashcards.
In this note
Introduction
The four Leopold manoeuvres
Describing the fetus
Measurements
Auscultation
Introduction
The obstetric examination describes how the fetus lies in the uterus and whether the mother and fetus are well. It combines general examination, abdominal palpation, measurement and auscultation.
Describing the fetus
The denominator is the occiput for vertex, the chin (mentum) for face and the sacrum for breech presentations, so the position is written as, for example, left occipito-anterior (LOA).
Measurements
Symphysis–fundal height and abdominal circumference, to follow growth.
External pelvimetry: distantia spinarum, cristarum, trochanterica, conjugata externa (see the topic on the bony pelvis).
Weight, blood pressure, oedema and urine protein at every visit.
Auscultation
The fetal heart is heard with a Pinard stethoscope from about 20 weeks, with a hand-held Doppler from 10–12 weeks, and best over the fetal back, below the umbilicus in a cephalic presentation and above it in a breech. The normal rate is 110–160 beats per minute. It must be told apart from the maternal pulse.
Where the heart is loudest tells you where the back is: left lower quadrant suggests a first (left) vertex position, above the umbilicus suggests a breech.
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