OBSTETRIC EXAMINATION

Obstetric Examination (I) is a competency-based clinical skills course designed to help undergraduate MBBS students develop a structured and systematic approach to the general and abdominal examination of a pregnant woman.

The course focuses on translating theoretical knowledge of pregnancy and fetal assessment into practical clinical skills. Through simulation-based demonstration, guided practice and competency assessment, students learn to perform an obstetric examination safely, respectfully and confidently.

The course covers assessment of the mother's general condition and vital signs, systematic abdominal inspection and palpation, measurement of symphysio-fundal height and abdominal girth, and assessment of important fetal parameters including lie, presentation, position, engagement and fetal heart rate.

Particular emphasis is placed on patient communication, informed consent, privacy, dignity, gentle examination technique, clinical interpretation, documentation and appropriate escalation of abnormal findings.

Learning Objectives

By the end of this course, the learner should be able to:

Knowledge

• Explain the purpose and components of obstetric examination.
• Describe the correct sequence of general and abdominal examination.
• Explain the clinical significance of maternal vital signs and general findings.
• Describe the principles of measuring symphysio-fundal height and abdominal girth.
• Define fetal lie, presentation, position and engagement.
• Explain the principles of fetal heart rate assessment.
• Recognize important abnormal findings requiring further evaluation.

Clinical Skills

The learner will be able to:

• Prepare the patient and examination area appropriately.
• Introduce themselves and confirm patient identity.
• Explain the examination and obtain informed consent.
• Maintain privacy, dignity and patient comfort.
• Perform a systematic general examination.
• Assess maternal pulse and blood pressure appropriately.
• Inspect the pregnant abdomen systematically.
• Perform abdominal palpation using appropriate technique.
• Measure symphysio-fundal height correctly.
• Measure abdominal girth using a consistent technique.
• Determine fetal lie and presentation.
• Identify the fetal back and assess fetal position.
• Assess engagement of the presenting part.
• Locate and assess fetal heart rate.
• Document examination findings accurately.
• Present and interpret findings in a structured manner.

Course Content

Module 1 — Preparation for Obstetric Examination

Students learn the correct approach to the pregnant patient, including:

• Hand hygiene
• Introduction and identification
• Explanation of the examination
• Consent
• Privacy and dignity
• Appropriate positioning
• Appropriate exposure
• Patient comfort and communication

Module 2 — General Examination

The course covers systematic assessment of:

• General appearance
• Nutritional status
• Pallor
• Icterus
• Cyanosis
• Edema
• Hydration
• Pulse
• Blood pressure
• Respiratory rate
• Temperature where indicated
• Weight and other relevant parameters

Students are taught to relate general examination findings to maternal wellbeing and possible pregnancy-related problems.

Module 3 — Abdominal Inspection

Students learn to assess:

• Abdominal size
• Shape and symmetry
• Scars
• Striae gravidarum
• Linea nigra
• Umbilicus
• Dilated superficial veins
• Visible fetal movements
• Abdominal tenderness or discomfort

Module 4 — Abdominal Palpation

Students practise systematic palpation to assess:

• Uterine size
• Uterine contour
• Fundal contents
• Fetal parts
• Fetal back
• Presenting part
• Fetal lie
• Presentation
• Position
• Engagement
• Tenderness

The focus is on correct hand placement, gentle technique and interpretation of findings.

Module 5 — Symphysio-Fundal Height

Students learn:

• Identification of the symphysis pubis
• Identification of the uterine fundus
• Correct placement of the measuring tape
• Measurement along the uterine contour
• Recording of the measurement
• Importance of serial measurements
• Factors that can influence SFH

Students are also introduced to the clinical significance of measurements that are smaller or larger than expected for gestational age.

Module 6 — Abdominal Girth

Students learn the principles of:

• Correct patient positioning
• Consistent measurement level
• Appropriate tape placement
• Avoiding excessive compression
• Accurate recording
• Interpretation in clinical context

Module 7 — Fetal Lie and Presentation

Students learn to differentiate:

Fetal Lie

The relationship between the fetal long axis and the maternal long axis.

Fetal Presentation

The fetal part occupying the lower uterine pole and presenting at the pelvic inlet.

Students practise recognition of:

• Longitudinal lie
• Transverse lie
• Oblique lie
• Cephalic presentation
• Breech presentation
• Other abnormal presentations where appropriate

Module 8 — Fetal Position and Engagement

Students learn to:

• Identify the fetal back.
• Identify fetal small parts.
• Determine fetal position in relation to the maternal pelvis.
• Understand the concept of engagement.
• Recognize that presentation, position and engagement are distinct clinical findings.

Module 9 — Fetal Heart Rate Assessment

Students practise:

• Identifying the fetal back.
• Selecting the appropriate area for auscultation.
• Using a Pinard fetal stethoscope or Doppler.
• Counting fetal heart rate appropriately.
• Distinguishing fetal heart rate from maternal pulse.
• Recording the finding.
• Recognizing when an abnormal finding requires further assessment.

Module 10 — Documentation, Interpretation and Presentation

Students learn how to:

• Record findings systematically.
• Interpret measurements in clinical context.
• Identify significant abnormalities.
• Communicate important findings to the supervising clinician.
• Present the obstetric examination in a structured clinical format.