Impending Premature Birth: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

• General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
  • Inspection (viewing).
    • Skin and mucous membranes
    • Abdominal wall and inguinal region (groin area).
  • Auscultation (listening) of the heart.
  • Auscultation of the lungs
• Gynecological-obstetrical examination.
  • Inspection
    • Vulva (external, primary female sex organs) [redness? coating? vesicles? scratch marks?]
    • Speculum setting:
      • Vagina (vaginal) [fluorine? color? foetor? blood?]
      • Cervix uteri (cervix), or portio (cervix; transition from cervix uteri to vagina (vagina)) [ Fluorine? color? Foetor? Ectopy? bleeding? Cervix shortened? opened? Amniotic sac visible? ], If necessary, take a Pap smear (for early detection of cervical cancer).
  • Palpation (palpation)
    • Cervix uteri (cervix) [shortened in % or cm? sacral (“referred to the sacrum“)? intermediate? centered? Cervix opened in cm or fingertip insertable? possibly assessment by Bishop score .see below]
    • Relationship of the preceding part of the child to the pelvis.
  • Palpation of the abdomen and uterus (womb).
    • Uterus [Soft? Ready to contract? Increased baseline tension? Contractions?]
    • Fundus stand – 1st Leopold’s grip (using both edges of the hand – starting at the costal arch – try to palpate the fundus stand/arched, upper edge of the uterus of the uterus/uterine. Later in pregnancy (late second and third trimester/third trimester), the position of the fetus can be determined; for example, in the case of breech presentation (BEL), the head of the child can be palpated in fundus) [Timely? What part of the child is in the 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, that is, whether there is cranial or pelvic end presentation; for this purpose, the examiner places his hand above the symphysis (pubic 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 presentation, this is not possible).

Square brackets [ ] indicate possible pathological (pathological) physical findings.

Bishop score

The Bishop score allows for a subjective, but reasonably comparable, assessment of birth maturity of the cervix or os. The higher the score, the more ready the cervix is to give birth.