Examination checklist

    Obstetric abdominal examination

    A 25-step mark sheet for the examination of the pregnant abdomen — general examination, inspection, fundal height, Leopold's manoeuvres, descent in fifths and fetal heart — with a model presentation and the causes of a fundal height that does not match the dates.

    OBGYN
    Obstetric examination
    All colleges

    Mark sheet

    25 steps · 25 marks

    #StepWellPartlyNot
    1. 1Greets the patient and examiner, introduces self, explains the examination and obtains consent1½0
    2. 2Offers a chaperone, ensures privacy and asks her to empty her bladder1½0
    3. 3Positions her supine with a left lateral tilt or a wedge, head on a pillow, and exposes from the xiphisternum to the symphysis pubis1½0
    4. 4General examination: pallor, jaundice, oedema, hydration, height and weight or BMI1½0
    5. 5Checks the blood pressure with the correct cuff size, sitting, and tests urine for protein1½0
    6. 6Inspects the abdomen: size and shape (ovoid longitudinal or transverse), fetal movements, linea nigra, striae1½0
    7. 7Inspects for scars — Pfannenstiel, midline, laparoscopic — and asks about them1½0
    8. 8Palpates gently for tenderness while watching her face, and notes uterine contractions and irritability1½0
    9. 9Palpates the fundus with the ulnar border of the hand, walking down from the xiphisternum1½0
    10. 10Measures symphysis–fundal height with the tape face down, from fundus to the top of the symphysis, then reads it1½0
    11. 11Compares fundal height in centimetres with the gestational age in weeks1½0
    12. 12Fundal palpation: identifies the pole in the fundus (breech broad and soft, head round, hard and ballotable)1½0
    13. 13Lateral palpation: both hands down the flanks to find the fetal back and limbs, and so the lie and position1½0
    14. 14Estimates liquor volume and notes any fetal parts that are unusually easy or hard to feel1½0
    15. 15Pelvic palpation facing her feet: identifies the presenting part and whether it is engaged1½0
    16. 16Pawlik's grip performed gently with one hand, only if pelvic palpation is unclear1½0
    17. 17Records descent of the head in fifths palpable above the pelvic brim1½0
    18. 18Checks for more than one fetus: count of poles, fundal height larger than dates1½0
    19. 19Estimates fetal weight clinically1½0
    20. 20Auscultates the fetal heart over the anterior shoulder with a Pinard stethoscope or Doppler for a full minute1½0
    21. 21Palpates the maternal pulse at the same time to confirm the heart rate is fetal1½0
    22. 22Offers to examine the rest of the patient: breasts, heart and lungs, legs for oedema and varicose veins1½0
    23. 23Covers the patient, helps her up, and thanks her1½0
    24. 24Presents the findings in order: fundal height, lie, presentation, position, engagement, fetal heart1½0
    25. 25Relates the findings to the gestational age and gives a conclusion1½0

    Summary of findings

    I examined Mrs C, a 29-year-old gravida 2 para 1 at 36 weeks by dates. She is not pale, not jaundiced, with mild pitting pedal oedema; her blood pressure is 120/70 mmHg and urinalysis is negative. The abdomen is uniformly enlarged, ovoid and longitudinal, moving with respiration, with a Pfannenstiel scar, linea nigra and striae gravidarum. It is non-tender, with no contractions. The symphysis–fundal height is 35 cm, compatible with the dates. There is a singleton fetus in a longitudinal lie and cephalic presentation, with the back on the left — left occipitoanterior — and the head 4/5 palpable. Liquor volume is clinically adequate and the estimated fetal weight is about 3 kg. The fetal heart is heard in the left lower quadrant at 140 beats per minute, regular. In summary, a singleton pregnancy at 36 weeks with findings compatible with dates in a woman with one previous caesarean section.

    Differential diagnoses

    FindingCauses to offer
    Fundal height 3 cm or more above datesWrong dates, multiple pregnancy, macrosomia (diabetes), polyhydramnios, fibroids, full bladder, maternal obesity
    Fundal height 3 cm or more below datesWrong dates, fetal growth restriction, oligohydramnios, transverse lie, engaged head, fetal death
    Oblique or transverse lieGrand multiparity, placenta praevia, polyhydramnios, uterine anomaly or fibroid, twins, contracted pelvis
    Head not engaged at term in a primigravidaOccipitoposterior position, placenta praevia, cephalopelvic disproportion, deflexed head, polyhydramnios
    Tense, tender uterusPlacental abruption, labour, chorioamnionitis, red degeneration of a fibroid

    See Large and small for dates and Fetal lie, presentation and position.

    Investigations

    • Ultrasound: fetal number, biometry and estimated weight, liquor volume, placental site, presentation
    • Blood and urine: haemoglobin or packed cell volume, urinalysis, oral glucose tolerance test if large for dates
    • Fetal wellbeing: umbilical artery Doppler if growth-restricted, CTG where available

    Treatment

    Plan the rest of the pregnancy and the delivery around the findings — for example external cephalic version for breech at term, delivery planning for a previous caesarean section, or serial growth scans for small for dates.

    Examiner questions

    References

    • Cunningham FG, Leveno KJ, Dashe JS, Hoffman BL, Spong CY, Casey BM, eds. Williams Obstetrics. 26th ed. New York: McGraw Hill; 2022.
    • World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva: WHO; 2016.

    Updated September 18, 2026