Preparation for Obstetric Examination
📌 Before examining, always explain the procedure to the patient and obtain verbal consent.
🚽 Ensure the patient has emptied her bladder as a full bladder interferes with fundal height estimation by pushing the uterus upwards, leading to falsely high measurements.
🧘 Position the patient in the dorsal supine position with hips and knees slightly flexed and knees wide apart to relax abdominal muscles.
🧍 The examiner should stand on the right side of the patient, fully exposing the abdomen from the pubic symphysis to the sternum.

Assessment of Uterine Size and Position
🔍 Inspection findings include looking for the linea nigra (pigmentation from umbilicus to symphysis) and striagravidarum (stretch marks).
📏 Fundal height estimation using the pubic symphysis to umbilicus division corresponds to 16 weeks (midway) and 24 weeks (at umbilicus).
📈 Fundal height estimation from the xiphisternum to the umbilicus involves thirds: 28 weeks, 32 weeks, and 36 weeks at the xiphisternum.
🤰 For a term-sized uterus with flanks full, the measurement may align with 32 weeks, indicating the baby's body occupies the flanks as the head descends.

Leopold's Maneuvers and Fetal Presentation
🤲 The first three Leopold's grips (fundal, lateral, and pawlik's grip) are performed facing the patient to assess the lie, presentation, and descent.
🦴 The right lateral grip felt knobby parts (fetal limbs) on the right, and a curved part (fetal back) on the left, suggesting a longitudinal lie with the back on the left.
🖐️ The fourth grip (pelvic grip) involves facing the patient's legs; if the hands do not converge below the presenting part, the head is likely engaged deep into the pelvis.
💨 To check for contractions, the uterus should be relaxed and indentable with gentle pressure; contraction causes hardening, preventing indentation and inducing patient pain.

Fetal Heart Sound (FHS) Location
💖 Fetal heart sounds are best transmitted and heard best over the fetal back side.
🎯 For an anterior position (e.g., Left Occipital Anterior - LOA), the FHS is best heard anteriorly.
📍 The optimal auscultation point is generally the midpoint of the line drawn between the umbilicus and the anterior superior iliac spine.
⬇️ As the head descends deeper into the pelvis, the FHS tends to move more towards the midline and downwards.

Key Points & Insights
➡️ Always obtain verbal consent and ensure the patient empties her bladder before beginning the examination to prevent measurement errors.
➡️ During palpation, centralize the uterus by correcting any lateral tilt before estimating fundal height.
➡️ Palpation of the uterus for contractions requires feeling for uterine relaxation; inability to indent the uterine wall signifies a contraction.
➡️ In the case described, the findings concluded a term-sized uterus with a cephalic presentation in the LOA (Left Occipital Anterior) position.

📸 Video summarized with SummaryTube.com on Jan 06, 2026, 17:14 UTC