Chapter 25: OBSTETRIC EXAMINATION

Obstetric examination
Obstetrical examination is uncommon in OSCEs because it is not easy to get an
enough number of pregnant women to act as standardized patient for a full day.
However, history taking and counseling scenarios are very common and
represent about 20% of any OSCE exam stations. Some OSCE organizers will
include non-pregnant women as first and second trimester pregnant
examinations and use manikins for third trimester examinations.
Even though, obstetrical examination is a skill that you will be assessed for all
through your medical practice. Following is the steps for all prenatal visits:

1. General inspection:
As you already had few seconds with the patient introducing your self, you
will be able to assess:
Overall health.
Nutritional status and pallor for anemia.
Neuromuscular deformities.
Emotional status: - Happy with the pregnancy or not?
- Signs of spousal abuse?
Blood pressure:
To the examiner “ The patient looks relaxed/ anxious. No obvious
neuromuscular deformities. No pallor or wasting. Until 24 week:
Happy and co-operates interactively.” sBP 5-10
dBP 10-15
2. Ask for Vital signs and Survey: mmHg
“What are her vitals, please? ” HR, RR, BP.
Carefully listen / read and comment: Nagele’s Rule:

To the examiner “Normal/ so, she has fever/tachycardia/ tachypnea….”. EDC =

1st day of LMP
“Ms…, let us check your weight, stand up on the scale please…., thank + 7 days
you.” – 3 months.
“How much was your weight immediately before this pregnancy.”
“When was the first day for your last period (LMP)?….. Was it
regular?… Every how many days it comes? Do you know your due Weight gain:
date (EDC)?” 0-12 weeks:
- Calculate gestational age. (If not given or to be sure). Loss < 5 lb.
- Calculate weight gain. 10-20 weeks:
To the examiner “Her gestational age is …., and weight gain is at … lb, 1 lb/ month.
normal/ less/ more for gestational age.” 20-40 week:
1 lb/ week.
Total 15-25 lb.

… Continued

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