GYN AbdominalClinical Exam OSCE

Phase	Step / Component	Key Actions & Considerations
Pre-Examination	1. Preparation & Setup	- Equipment: Gather measuring tape, Pinard stethoscope or doppler, watch with second hand, ultrasound gel.
	2. Patient Interaction & Positioning	- Communication: Wash hands, introduce yourself, explain the procedure’s need and nature, and obtain verbal consent. - Privacy & Comfort: Be accompanied by a female chaperone, expose only the necessary area. - Positioning: Patient should have an empty bladder and lie in a semi-recumbent dorsal position. Stand on her right side. Roll her slightly to the left to reduce vena cava compression.
General Assessment	3. Vital Signs & Measurements	- Apperance: - Vitals: Check Blood Pressure, Pulse/Heart Rate, Respiratory Rate, and Temperature. - Anthropometry: Measure and record weight (noting gain) and height (noting short stature).
	4. General Physical Exam	- Observe: Gait, psychological status, signs of specific diseases (e.g., thyrotoxicosis). - Face/Eyes/Tongue: Check for chloasma, pallor, jaundice, cyanosis, dehydration, stomatitis. - Systemic Review: Briefly cover CNS, GIT, Urinary, and Locomotor systems.
Abdominal Examination	5. Inspection	- Observe the abdomen for size, shape, fetal movements, surgical scars, linea nigra, striae gravidarum, dilated veins, and umbilicus condition.
	6. Palpation (Leopold Maneuvers)	- Superficial Palpation: Assess for tenderness (ask first), organomegaly, and uterine contractions. - 1st Fundal Grip (Fundal Height): Use the ulnar border of the left hand to locate the fundus. Measure with tape in cm. Correlate with gestational age (±2 cm after 20 weeks). Interpret if measurement is significantly larger or smaller. - 2nd Fundal Grip (Leopold I): Use both hands to determine the fetal part in the fundus (head: hard, smooth, round; breech: soft, irregular, broad). - Lateral Grips (Leopold II): Palpate the sides of the uterus to determine fetal lie and locate the fetal back (hard, regular surface). - 1st Pelvic Grip: Determine which fetal part is occupying the pelvis. - 2nd Pelvic Grip: Assess for engagement of the presenting part, try to get under symphysis pubis, if its case, its not engaged.
	7. Auscultation	- Fetal Heart Sounds (FHS): After locating the back, use a Pinard or doppler to listen to the FHS. Auscultate below the umbilicus for cephalic presentation and above for breech. Count the rate for one full minute.
Post-Examination	8. Completing the Exam	- Internal Exam: Perform a Vaginal Examination (PV) if indicated, with the patient in the lithotomy position. - Concluding: Inform the patient the examination is finished and cover.
	9. Documentation & Summary	- Record: Document all findings accurately. - Communicate: Thank the patient for her time. - Summarize: Provide a concise summary of the examination findings.