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 examination
- Inspection
- Vulva (external, primary female sex organs) [inflammation?]
- Speculum setting
- Vagina (vaginal) [fluorine? blood? mucus? amniotic fluid? ]
- Cervix uteri (cervix), or portio (cervix; transition from cervix uteri to vagina (vagina)). [Closed? Opened? Amniotic sac visible or broken?]
- 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/contractions?]
- Fundus stand – 1st Leopold’s hand hold (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. In the later course of pregnancy (late second and third trimester / third trimester), the position of the fetus can be determined; so, for example, in breech presentation (BEL) the head of the child can be palpated in fundus) [timely? too low as a sign of a ev. growth retardation / growth retardation, symphysis fundus distance measurement as a possible indication of growth retardation, which 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/uterine; 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 entrance.
- 3rd Leopold’s grip: head or rump preceding? (Requires that the preceding part is still wholly or largely over the pelvic entrance and can be moved).
- 4. leopold’s handgrip (serves to determine the position of the fetus, i.e., whether there is a 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 index finger (́ballotiereń); if the child is in a pelvic end presentation, this is not possible): It is used to check the extent to which the preceding part has already entered the pelvis
- Inspection
Square brackets [ ] indicate possible pathological (pathological) physical findings. 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 |
Cervix length (length of the “vaginal part of the uterus) | > 2 cm | 1 cm | elapsed | – |
Portio position | sacral | mediosacral | 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 | 1 cm above or in the interspinal plane | below the interspinal plane | – |