A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body weight, height; further:
- Inspection (viewing).
- Skin and mucous membranes
- Abdominal wall and inguinal region (groin area).
- Auscultation (listening) of the heart.
- Auscultation of the lungs
- Inspection (viewing).
- Gynecological-obstetrical examination.
- Inspection
- Vulva (external, primary female sex organs) [redness? coating? vesicles? scratch marks?]
- Speculum setting
- Vagina (vaginal) [fluorine (discharge)? color? fetor (“unpleasant odor”)? blood?]
- Cervix uteri (cervix), or portio (cervix; transition from cervix uteri to vagina (vagina)) [Fluorine? foetor? bleeding? cervix shortened? opened? amniotic base visible?]
- Palpation (palpation)
- Cervix uteri (cervix) [shortened in % or cm? sacral (“referred to the sacrum”)? intermediate? centered? Cervix opened in cm or finger patency? possibly assessment by Bishop score see below]
- Relationship of the preceding part of the child to the pelvis.
- Palpation of the abdomen (belly) and uterus (womb).
- Uterus [Soft? Ready to contract? Increased baseline tension? Contractions (contractions)?]
- Fundal level (upper edge of uterus) – 1st Leopold’s grip (both edges of the hand are used – starting at the costal arch – to try to palpate the fundal level of the uterus/uterus. Later in pregnancy (late second and third trimester/third trimester), the position of the fetus can be determined; for example, in breech presentation (BEL), the baby’s head can be palpated in fundus) [Timely? What part of the baby is in fundus].
- Position of the back and small parts – 2nd Leopold’s handgrip (used to determine the position of the child’s back, hands are placed to the left and right of the palpable uterus; light pressure is used to palpate the arms and legs (small parts) on one side and the back on the other).
- Relationship of the preceding part to the pelvic inlet – 3rd Leopold’s handgrip (used to determine the position of the fetus (cranial or pelvic end position?); for this purpose, the examiner places his hand above the symphysis and tries to push the child’s skull back and forth with his thumb and forefinger (́ballotiereń); if the child is in pelvic end position, this is not possible).
- Inspection
Bishop score
The Bishop score allows a subjective, but reasonably comparable, assessment of the birth maturity of the cervix or os. The higher the score, the more ready the cervix is to give birth.
| Findings | 0 points | 1 point | 2 points | 3 points |
| Cervical length (length of the vaginal portion of the cervix) | > 2 cm | 1 cm | elapsed | – |
| Portio position | sacral (“relating to the sacrum”) | mediosacral (“toward the sacrum near the leading line”) | centered | – |
| Portioconsistency | derb | medium | soft | – |
| Cervix width | Closed | 1 cm | 2 cm | > 3 cm |
| Height level of the preceding part | 2 cm above the interspinal plane (an imaginary line connecting the ischial spines) | 1 cm above or in the interspinous plane | below the interspinal plane | – |
Square brackets [ ] indicate possible pathological (pathological) physical findings.
