Four-step palpation method for obstetrics

The four-step palpation method is the most common method of pregnancy examination and begins after the 24th week of pregnancy. The four-step palpation method can be used to determine the position and size of the fetus, whether the size of the uterus is consistent with the number of weeks of pregnancy, the birth method, presenting part, fetal position, etc., and estimate the amount of amniotic fluid in the pregnant woman.

(l) Posture for pregnant women: After urinating, lie on your back with your head slightly raised, your abdomen exposed, and your legs slightly bent and separated to release pressure on your abdomen.

(2) Operator: Stand on the right side of the pregnant woman to conduct the examination; when doing the first three steps, face the pregnant woman; when doing the fourth step, face the pregnant woman's feet.

(3) Techniques

Step 1: The operator places both hands on the fundus of the uterus, measures the height of the fundus, and estimates whether the size of the fetus is consistent with the number of weeks of pregnancy. Then use the two fingertips to push gently in opposite directions to determine the position of the fetus at the bottom of the uterus. If it is the head, it is hard and round and has a pump pressure switch feeling. If it is the buttocks, it is soft and wide and has a slightly irregular shape.

Step 2: The operator places both hands on both sides of the abdomen, with one hand fixed and the other hand gently pressing deeply to test, alternating between the hands from top to bottom. The flat and round part is the tire back, and it is clear whether the tire back is forward, sideways or backward. The deformable uneven part that touches is the fetus's body, and sometimes you feel that the fetus's body is moving.

Step 3: The operator separates the left thumb from the other four fingers, places them on the ischial tuberosity to hold the presenting part, further confirm whether it is the fetal head position or the fetal buttocks, and then pushes up and down to determine whether it is aligned. If the presenting part can still move up and down, it indicates that it is not connected to the human basin. If docked, the presenting part cannot be advanced.

Step 4: The operator places his left and right hands on both sides of the presenting part respectively, and presses deeply down along the pelvic inlet to further check whether the identification of the presenting part is appropriate and to determine the level of the presenting part. When the fetal head is presented, one hand can fully enter the pelvic incision, while the other hand is blocked by the protrusion of the fetal head, which is called the fetal head bulge. In occipital presentation, the bulge of the fetal head is the frontal bone, which is in the same direction as the baby's body; in face presentation, the bulge of the fetal head is the occipital bone, which is in the same direction as the fetal back.