what does presentation mean on maternity notes

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Understanding your maternity notes

Your maternity notes are an important record of your pregnancy, and it's where your midwife will add details of your health and your baby's development during each of your appointments.

But with their abbreviations and medical terms, these antenatal notes are notoriously tricky to understand. To help you decipher them, we asked midwife Leah Hazard to decode the medical jargon that you'll see over the next nine months.

What are maternity notes?

These are either written or digital notes completed by your midwife. You'll usually be in charge of looking after your maternity notes and, if you have handheld notes, you'll need to take them to each midwife appointment.

You'll also need to take them with you wherever you go, including on holiday, just in case you need medical help while you're away.

Your notes will usually have telephone numbers for you to use if you need to speak to anyone, a space to write the date and time of your next appointment and a record of what you told your midwife in the booking appointment.

What else is in my maternity notes?

They are an important record of every stage of your pregnancy. And while you may be familiar with terms like BP (blood pressure), other abbreviations like FH (fetal heartbeat) are likely to be completely new. Leah says:

'Your midwife will perform a detailed assessment of your health and your baby’s wellbeing at every appointment.

‘You may be familiar with some parts of these assessment, like having your blood pressure checked and your urine dipped. But other parts, like abdominal palpation (feeling your ‘bump’ carefully for fetal size, position and presentation) or auscultation (listening in to your baby’s heartbeat) may be new to you.

'Always ask your midwife to explain anything that’s unclear,' she adds.

In the meantime, here's a complete guide to your maternity notes...

'About you' section

Gravida, or g.

This refers to the number of times you've been pregnant. If you're pregnant for the first time, your notes might say primigravida; if you've had a previous pregnancy, they'll say multigravida.

If you're pregnant for the first time and are over 35, you could see yourself referred to as an 'elderly primigravida'.

Parity, or P

This is how many times you've given birth. Nulliparous means you've never given birth. Primipara or primip means you've given birth once.

Multipara or multip means you've had two or more babies. Grand multipara means you've given birth three or more times.

Your ‘parity’ (the number of times you’ve given birth) can also be expressed as a sum that includes any losses you’ve had; for example, para 2+1 indicates a woman who has given birth to two babies over 24 weeks’ gestation, and has had one loss of under 24 weeks’ gestation.

A ‘loss’ could be a miscarriage or termination; your midwife will ask sensitively about any of these at your first appointment.

This is how many weeks pregnant you are.

Your gestation is shown in a sum of weeks and days, and is initially measured from the first date of your last menstrual period (LMP). For example, if it’s been six weeks and four days since your last period began, then your gestation will be written as 6+4.

Your EDD (estimated date of delivery, or estimated due date) will also be calculated initially going by your last period, but may be modified slightly once you’ve had your dating scan and your baby’s size is measured more accurately.

If you’ve gone past your EDD (over 40 weeks pregnant), your gestation may be written in relation to ‘term’ (full gestation) – for example, if you’re five days over your due date, your midwife may write that you’re ‘Term plus 5’ or ‘T+5’.

This is your body mass index – a calculation that indicates the ratio of your height to weight. Both measurements will be taken at your booking appointment.

Although BMI is not a perfectly accurate indicator of a woman’s health, it can be helpful to healthcare providers in giving a rough indication of whether you’re maintaining a healthy weight.

If you’re concerned about your weight, talk to your midwife or doctor about ways of managing this in pregnancy.

Photo credit : Shutterstock

Your health checks.

Blood pressure . This will be taken at every antenatal appointment and is recorded as two numbers, a ‘systolic’ over a ‘diastolic’ measurement, such as 120/75.

If your blood pressure readings are consistently high (above roughly 140/90), your midwife may refer you for further assessment.

Full blood count. This measures a number of blood components including haemoglobin (an indicator of your iron levels), white blood cells (which can be elevated in the presence of infection) and platelets (which influence your blood’s ability to clot).

You can expect an FBC to be taken two or three times in your pregnancy.

Mid-stream urine. Your midwife will request a urine sample from you at each appointment.

She'll dip it with a piece of special litmus paper that can detect various substances including ketones (a sign of possible dehydration), glucose (often high in the presence of diabetes ), red and white blood cells (sometimes present with infection) and protein (sometimes just a result of contamination with vaginal discharge, and sometimes an indicator of possible pre-eclampsia if accompanied by high blood pressure).

The amount of each substance in your urine will be expressed with a + sign (for example, glucose + protein ++) or, if the sample is clear, the midwife may write NAD (no abnormality detected).

Short for oedema, or swelling: often a normal symptom of late-term pregnancy, but sometimes also a symptom of pre-eclampsia if accompanied by high blood pressure and protein in the urine.

Your midwife assesses this based on how you look and the symptoms you describe, and again records it as +, ++ or +++.

Your baby's heart rate and movements

Fh, fhh or fhhr.

This stands for either fetal heart, fetal heartbeat heard, or fetal heartbeat heard and regular, and will be accompanied by the beats per minute (bpm) – normally an average of 105 to 160bpm; so, for example, FH 146bpm.

The midwife may listen to your baby’s heartbeat with a handheld Doppler monitor (sometimes called a Sonicaid), or she may check it with a Pinard (small wooden or metal ear-trumpet that can be pressed against your abdomen).

If your baby’s heartbeat is high, this may just be a normal acceleration due to fetal movement; your midwife may wish to listen for longer than a minute to see if this settles.

If there are any sustained concerns about the fetal heart rate, you may be referred to the local assessment unit for further review.

Your midwife will ask if you're feeling your baby move, and if you are, will record it as FMF (fetal movements felt). If she can actually feel the baby move when she palpates (feels) your abdomen, she may write, ‘FMF on palpation’.

Your baby's size

This stands for crown-rump length and is the measurement from the top of your baby's head to the base of their spine. It's taken at the dating scan and is a reliable way to calculate your due date.

Abdominal circumference. As your pregnancy progresses, this measurement around your baby’s belly is a more accurate indicator of their growth, and may be plotted on a special growth chart in your hospital case notes and/or your handheld notes.

Fundal height - the distance from the top of your uterus to your ‘symphysis pubis’ (the bony prominence at the front of your pelvis).

Your midwife will usually measure fundal height with a simple tape measure from around 28 weeks’ gestation, and will record her findings in centimetres.

This is a rough guide of fetal growth, and if your midwife has any concerns, she will refer you for an ultrasound scan. Babies who are measuring smaller than expected on scan may be referred to as SFD (small for dates) or LFD (large for dates).

Your baby's position

Ceph: short for cephalic, which means your baby is lying head down in the uterus.

Br : short for breech, or bottom/feet down.

Long : not your baby's length, but short for longitudinal, which means your baby is in a vertical position.

Tr : this is short for transverse, where your baby lies horizontally across your bump.

Obl : oblique, or lying diagonally in the womb.

OA : occiput anterior, which means your baby is head down and facing your back.

OP : short for occiput posterior, where your baby is head down but ‘back to back’ (with its spine laying against your spine)

R or L : in front of OA and OP, this refers to which side of your body your baby is lying on. For example, ROA means right occipito-anterior; your baby is head down, facing slightly towards your right, with its back towards the front of your abdomen.

Your baby's position in your pelvis

E or Eng : this is short for engaged, which means that part of your baby's head has dropped below the brim of your pelvis.

If this is your first baby, it’s possible that your baby’s head will be at least partly engaged days or even weeks before you give birth.

However, if this is your second or subsequent baby, it’s more likely that your baby’s head won’t engage until the onset of labour.

1/5, 2/5, 3/5, 4/5 and 5/5 : this is a measurement of how much of your baby's head - in fifths - your midwife can feel above your pelvis when she palpates (feels) your abdomen.

For example, 3/5 means the midwife can feel most of your baby’s head above your pelvic brim, with 2/5 of its head engaged into your pelvis.

Free : this means your baby's head is ‘free’ above the brim of your pelvis, or not engaged.

Your maternity notes will also include:

• the date of your first antenatal visit and the date your baby is expected
• any problems or care you've needed during your pregnancy
• details of your  ultrasound scans and other appointments
• details of any reasons you had to go to an NHS antenatal ward or day assessment unit at your local hospital
• details of your plan for your baby's birth , including pain relief , and whether you plan to give birth at hospital, home or birth centre
• details of monitoring your baby's heartbeat
• when and how your medical team may intervene to assist your labour
• how you plan to feed your baby
• how long you plan to stay on the postnatal ward after giving birth

Are you pregnant and looking for further support and information? Head over to our pregnancy hub or join your due date club in our forum.

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Pregnancy maternity notes: understanding them

Read time 5 minutes

If you’re feeling a bit confused by it all, here’s what you might want to know about your notes

What are your maternity notes or maternity notes folder?

Maternity notes, or handheld notes, are a record book/folder where your midwife will note down details of each appointment. They’re a standardised, national maternity record and you’ll need to take them with you to each antenatal appointment.

When to take them with you

Take your maternity notes wherever you go (within reason…) including on holidays, in case you need medical attention when you’re away from home. It might not be easy to understand everything in your notes, so it’s a good idea to ask your maternity team to explain anything you’re unsure about.

What’s in your maternity (handheld) notes

Your maternity notes contain the following information:

• Your name, address and hospital number and details.
• Your medical history including any disease you are currently suffering from and medications you are taking.
• Your family medical history, for example if any of your family members suffered from medical conditions like diabetes, blood pressure etc.
• Information about previous pregnancies and births.
• Your appointment times.
• Results of blood tests and investigations including ultrasound scans.
• Phone numbers for your midwife, birth suite and hospital etc.
• Information collected by your midwife during antenatal checks. This includes your blood pressure, urine tests, vaccines taken, foetal movements and foetal heart. It also includes the way your baby is lying in the womb and engagement – how deep the baby’s head is below the brim of the pelvis.
• Assessment of the baby’s growth inside the womb.
• Any problems encountered during pregnancy.
• Preferences for birth, eg where you would like to give birth, who’ll be your birth partner, what pain relief methods you would like.
• When your labour started and how it progressed. This will include foetal heart monitoring, your posture during labour and delivery, what type of birth you had and how the placenta was delivered.

Pamphlets and extra information

As well as all the above information about you, you may be given:

• Phone numbers for charities that work with parents and babies.
• Pamphlets on topics you might find interesting, eg breastfeeding, eating well when you’re pregnant.
• Advice on issues during pregnancy.

Meaning of abbreviations used in maternity notes

Urine test results (for presence of protein or sugar)

NAD: nothing abnormal detected

Nil: none found

Tr (trace): small amount of sugar or protein found

+ , ++ , +++: presence of greater amount or protein

Heartbeat or activity

FHH: foetal heart heard

FHHR: foetal heart heard and regular

FHNH: foetal heart not heard

FMF: foetal movements felt

Position of your baby – the way it is lying in the womb

L: longitudinal (length-wise)

O: oblique (slanting)

T: transverse (sideways)

Which part it presents towards the birth canal

C: cephalic (head first – also called as vertex)

B or Br: bottom first or breech

OA: occiput anterior (head down, facing your back)

OP: occiput posterior (head down, facing your front)

OL: occiput lateral (head down, facing your side)

L or R in front of these tell you which side of your body your baby is.

Engagement of baby’s head in the pelvis

NE, NEng, Not Eng: not engaged

E or Eng = engaged

4/5 = sitting on the pelvic brim

3/5 = lower but most still above the brim

2/5 = engaged, as most is below the brim

1/5 or 0/5 = deeply engaged.

If it’s your first baby, engagement tends to happen in the last weeks. In subsequent pregnancies, it may happen later or even not until labour has started.

This page was last reviewed in May 2018.

Further information.

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

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Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

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Understanding Your Maternity Notes

A look at the abbreviations you might notice on your notes from your LMC and what they mean.

Alb – Albumin. A protein in your blood which indicates how well your kidneys are working.

BP – Blood Pressure

EDD – Estimated Due Date

D – Descent. How far or deep into your pelvis your baby’s head is. This is measured in 5ths with 5/5 being completely above the pelvis and 0/5 being completely in the pelvic cavity.

Eng – Engagement. When your baby’s head moves down into your pelvis, at a descent evaluation of 2/5 or less.

FMF – Fetal Movement Felt. Your LMC will write this when they felt your pēpi kick during a check-up.

Fundus – Fundal height. The distance in centimetres from the top of the pubic bone to the top of the uterus. The measurement approximately corresponds to the week of pregnancy i.e. 30 weeks ≈ 30 cm.

FHHR – Fetal Heart Heard Regular

GLU – Glucose aka sugar

GFM – Good Fetal Movements

Hb – Haemoglobin. A protein found in your red blood cells that carry oxygen around your body. Iron is crucial for the production of haemoglobin. If you have low Hb levels you may need iron supplementation .

LMP – Last Menstrual Period. The date used to calculate your baby’s estimated due date.

NAD – No Abnormality Detected. It means everything seems normal.

OED/Oedema – Swelling

PRES – Presentation . The way your baby is lying, either head down, head up (breech), or sideways (transverse).

Pos – Position . The way your baby is facing in relation to your pelvis.

T or Tr – Trace. This is in reference to the presence of protein or glucose found in your urine .

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What do my maternity notes mean?

Read on for your guide to understanding your maternity notes.

Introduction

What are maternity notes for.

• What's in your maternity notes?

What do the maternity notes abbreviations mean?

When you’re pregnant, it’s hard enough taking in all the changes to your life and to your body, let alone what your maternity notes mean. This guide will help you translate them into plain English.

At your first appointment with the midwife, you will be given a personal pregnancy record book called your maternity notes. Always keep them somewhere handy. And remember to bring them to all your antenatal appointments, and importantly, when you go into hospital to give birth.

As well as a record of all your tests and scans, your maternity notes are a reference guide. They include all the emergency numbers and some general advice and tips for staying well during your pregnancy. They are useful documents to have so read through them with your partner. Have questions for your first midwife appointment? Why not check out our checklist Questions to ask at the first midwife appointment .

What's in your maternity notes?

Any illnesses you have had in the past that may influence your pregnancy and labour

Your present health and any conditions or medicines that you are taking

The health of close family members, so your midwife can check whether your baby might inherit a condition that runs in your family

Any information about any previous pregnancies

The date of your first antenatal visit and your due date. Yet to find out your due date? Why not find out with our pregnancy due date calculator .

The results of blood tests

Any checks your midwife has carried out at the antenatal clinic

Blood pressure readings, and urine test results

Measurements of your bump and a log of the positions your baby is lying in, later on in the pregnancy

Details of your ultrasound scans. If you’re yet to have one, check out what to expect at your first pregnancy scan .

A customised growth chart for your baby

Your birth plan including any preferences for pain relief

Here’s a list of the most common abbreviations you might see in your maternity notes and what they mean.

16+2 The length of your pregnancy (i.e. 16 weeks and two days)

ANC Antenatal clinic

BP Blood pressure

Br Breech (baby is bottom down)

Ceph Head down

CS Caesarean section

E Head engaged

ECV External cephalic version (when your breech baby is turned externally by hand)

EDD Estimated date of delivery

Eng Head engaged

FHH Fetal heart heard

FHNH Fetal heart not heard (this is often because your baby is lying in an awkward position)

FMF Fetal movements felt

FMNF Fetal movements not felt (this usually means your baby is resting)

GTT Glucose tolerance test (for pregnancy related gestational diabetes)

HB Haemoglobin (an indicator of how much iron you have in your blood)

IOL Induction of labour

LMP Last menstrual period

LOA Left occipital anterior (the back of your baby’s head is on your left-hand side and towards to your belly button)

LOP Left occipital posterior (the back of your baby’s head is on your left-hand side and towards your spine)

MSU Midstream urine

NAD No abnormality detected

NT Nuchal translucency (fluid under the skin at the back of your baby’s neck which is measured at your first ultrasound at around week 11 of your pregnancy)

PET pre-eclampsia toxaemia (a condition in pregnancy that refers to high blood pressure, swelling and protein in urine)

Rh Rhesus factor (On your first antenatal appointment, your blood will be tested to find out which type you are – A, B, AB or O - and your rhesus status – positive or negative)

ROA Right occipital anterior (the back of your baby’s head is on your right-hand side and towards the front of your tummy)

ROP Right occipital posterior (the back of your baby’s head is on your right-hand side and towards your back)

USS Ultrasound scan

UTI Urinary tract infection

VE Vaginal examination

VX Vertex (part of your baby's head)

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Your antenatal 'notes'.

Your pregnancy 'notes' is the book in which all the information about your medical history and your pregnancy is recorded.

During your first antenatal appointment, called the  booking appointment , your midwife will start a record. This is called your ‘notes’. At every appointment your midwife or doctor will record what happens in your notes.

You will usually look after your notes. Take good care of them, as usually there is no copy. Keep them with you at all times in case of an emergency and ask if there’s anything you don’t understand.

Your notes will also usually have telephone numbers for you to use if you need to speak to anyone, a space to write the date and time of your next appointment and a record of what you told the midwife in the booking appointment.

Pregnancy notes terms and abbreviations

To help you make sense of what your midwife or doctor has written, here are the most common terms and abbreviations that they might use:

BP, or blood pressure

This is the force with which your heart pumps blood around your body. Your blood pressure is recorded at each antenatal appointment. High blood pressure could be a symptom of a condition such as pre-eclampsia .

BR, or breech

Breech is a word for a position your baby could be in. It means that their bottom or feet are facing down towards your pelvis and the head is at the top of the womb. The ideal birthing position for your baby is head down so if your baby is breech towards the end of pregnancy your midwife or doctor will talk to you about trying to change their position using a technique called ECV (External Cephalic Version) .

CEPH, or cephalic

This refers to the position of your baby and means that his or her head is faced down towards your pelvis. This position is ideal for giving birth.

Cx, or cervix

The cervix is the neck of your womb (uterus). It is a short passage between the vaginal canal and the womb. It will start to open up from the womb downwards when you go into labour. If your cervix opens early you may go into premature labour.

This means 'did not attend' and it is put on the notes if you do not attend a planned appointment.

EDD stands for 'estimated date of delivery' - the date your baby is due.

This is the chemical symbol for iron. If you have symptoms of anaemia (iron deficiency), you will be tested for low iron levels.

FH, or fetal heart

This is your unborn baby's heartbeat. This is checked at antenatal appointments by your midwife.

This stands for 'fetal heart heard regular', which means that the midwife or doctor has heard your baby's heart.

This stands for 'fetal movement felt'. Your midwife or doctor will write this when they have felt your baby moving.

Fundal height

This is the height of your bump, which your midwife or doctor will measure as your baby grows.

Hb, or haemoglobin

This is the part of your red blood cells that carries oxygen around your body. A low haemoglobin level means you are anaemic and will need extra iron.

This stands for 'last menstrual period' and refers to the first day of your last period, which is used to work out when your baby is due.

This stands for 'midstream sample of urine'. You may be asked to give a midstream sample when your midwife or doctor needs to test your urine. It means taking a sample that is not and the beginning or the end of urinating.

Multigravida

This means that you have been pregnant before. This includes any pregnancies that ended in loss.

This stands for 'nothing abnormal detected'.

Oed, or oedema

This means swelling because of water retention.

This means you have had no pregnancies that have gone beyond 24 weeks.

This means you have had one other pregnancy that has lasted for longer than 24 weeks. (Para 2 means two pregnancies and so on.)

PET, or pre-eclampsia

Pre-eclampsia is a potentially dangerous pregnancy condition and your midwife and doctor will check for signs each time they see you.

Primigravida

This means that you are pregnant for the first time.

SFH, or symphysis fundal height

This is the height of your baby, measured from your pelvis.

This stands for 'to come again' and just means that you need another appointment.

TR or trace

This means that tiny amounts of substances such as sugar or protein have been found in your urine. If more has been found, '+' will be used instead.

This stands for vaginal - or internal - examination. If your pregnancy is uncomplicated you are unlikely to have a vaginal examination until you go into labour.

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Presentation and position of baby through pregnancy and at birth

9-minute read

If you are concerned about your baby’s movements, contact your doctor or midwife for advice immediately.

• If you baby is in a breech presentation, your doctor may recommend trying a technique called an external cephalic version to try and move your baby while they are still in the uterus for an easier birth.

What does presentation and position mean?

Presentation refers to the part of your baby’s body that is facing downwards in the direction of the birth canal.

Position refers to where your baby’s occiput (the bottom part of the back of their head) is in relation to your body.

If your baby is in a breech presentation , then position refers to where your baby’s sacrum (lower back) is in relation to your body.

People — including medical professionals — sometimes use these terms incorrectly. Sometimes when speaking about babies in breech presentation, the word ‘position’ will be used to refer to their presentation. For example, you may read information or hear people say ‘breech position’ instead of ‘breech presentation’.

What are the different types of presentation my baby could be in during pregnancy and birth?

Most babies present headfirst, also known as cephalic presentation. Most babies that are headfirst will be vertex presentation. This means that the crown of their head sits at the opening of your birth canal.

In rare cases, your baby can be headfirst but in face or brow presentation, which may not be suitable for vaginal birth.

If your baby is in a breech presentation, their feet or bottom will be closest to your birth canal. The 3 most common types of breech presentation are:

• frank or extended breech — where your baby’s legs are straight up in front of their body, with their feet up near their face
• complete or flexed breech — where your baby is in a sitting position with their legs crossed in front of their body and their feet near their bottom
• footling breech — where one or both of your baby’s feet are hanging below their bottom, so the foot or feet are coming first

Read more on breech presentation .

What are the different positions my baby could be in during pregnancy and birth?

If your baby is headfirst, the 3 main types of presentation are:

• anterior – when the back of your baby’s head is at the front of your belly
• lateral – when the back of your baby’s head is facing your side
• posterior – when the back of your baby’s head is towards your back

How will I know what presentation and position my baby is in?

Your doctor or midwife can usually work out your baby’s presentation by feeling your abdomen. They may also double check it with a portable ultrasound. Your baby’s presentation is usually checked around 36 weeks .

Your doctor or midwife will also confirm your baby’s head position in labour by examining your belly and using an ultrasound , and they may also do a vaginal examination . During the vaginal examination they are feeling for certain ridges on your baby’s head called sutures and fontanelles that help them work out which way your baby is positioned.

What is the ideal presentation and position for baby to be in for a vaginal birth?

For a vaginal birth, your baby will ideally be headfirst with the back of their head at the front of your belly, also known as being in the anterior position. This position is best for labour and birth since it means that the smallest part of your baby’s head goes down the birth canal first.

When does a baby usually get in the ideal presentation and position for birth?

Your baby will usually be in a headfirst position by 37 weeks of pregnancy. Around 3 in every 100 babies will be in breech presentation after 37 weeks.

Your baby’s position can change with your contractions during labour as they move down the birth canal, so their exact position can change during labour.

What are my options if baby isn't in the ideal presentation or position for a vaginal birth?

If your baby is in a breech presentation, your doctor may recommend a technique called an external cephalic version (ECV) to try and move your baby while they are still in the uterus . An ECV involves your doctor using their hands to apply pressure on your belly and help turn your baby to a headfirst position. It has a 1 in 2 chance of success and is a safe option in most pregnancies.

There is no evidence to show that alternative therapies, such as exercises, acupuncture or chiropractic treatments, help your baby change from a breech presentation to headfirst.

If your baby remains breech, your doctor may discuss having a breech vaginal birth. Not all doctors and hospitals offer this option. They may also suggest you birth your baby with a planned caesarean section .

If your baby’s presentation is headfirst but the position of your baby’s head is not ideal for labour, it can lead to a longer labour, and potential complications . The position of your baby’s head will often change as your labour progresses. If it doesn’t, sometimes you can still give birth without assistance, or you may need your doctor to help turn your baby’s head or help your birth with a vacuum or forceps .

Any procedure or decision for a type of birth will only go ahead with your consent . You will be able to discuss all the options with your doctor, and based on your preferences for yourself and your baby’s safety, make a decision together .

Resources and support

The Royal Australian and New Zealand College of Obstetrics and Gynaecology has a factsheet about the options available to you if your baby is in a breech presentation at the end of your pregnancy .

Mercy Perinatal has information on external cephalic version (ECV) safety and benefits if your baby is in a breech presentation at the end of your pregnancy.

The Women’s Hospital has information about the different presentations and positions your baby could be in, and how it can affect your birthing experience.

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Last reviewed: October 2023

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External cephalic version (ecv), malpresentation, breech pregnancy, search our site for.

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Breech presentation and turning the baby

In preparation for a safe birth, your health team will need to turn your baby if it is in a bottom first ‘breech’ position.

Read more on WA Health website

Breech Presentation at the End of your Pregnancy

Breech presentation occurs when your baby is lying bottom first or feet first in the uterus (womb) rather than the usual head first position. In early pregnancy, a breech position is very common.

Read more on RANZCOG - Royal Australian and New Zealand College of Obstetricians and Gynaecologists website

External Cephalic Version for Breech Presentation - Pregnancy and the first five years

This information brochure provides information about an External Cephalic Version (ECV) for breech presentation

Read more on NSW Health website

When a baby is positioned bottom-down late in pregnancy, this is called the breech position. Find out about 3 main types and safe birthing options.

Read more on Pregnancy, Birth & Baby website

Malpresentation is when your baby is in an unusual position as the birth approaches. It may be possible to move the baby, but a caesarean may be safer.

Labour complications

Even if you’re healthy and well prepared for childbirth, there’s always a chance of unexpected problems. Learn more about labour complications.

ECV is a procedure to try to move your baby from a breech position to a head-down position. This is performed by a trained doctor.

Having a baby

The articles in this section relate to having a baby – what to consider before becoming pregnant, pregnancy and birth, and after your baby is born.

Anatomy of pregnancy and birth - pelvis

Your pelvis helps to carry your growing baby and is tailored for vaginal births. Learn more about the structure and function of the female pelvis.

Planned or elective caesarean

There are important things to consider if you are having a planned or elective caesarean such as what happens during and after the procedure.

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Your antenatal notes can be a bit confusing. We help you decipher what it all means …

Pregnancy Health – 11 Jan 19 By bountyteam

Understanding the lingo can be tricky!

You're entitled to hold onto and review your antenatal notes in your own time and, although some health authorities don't routinely give them to women, you can still ask for them. Remember to take them to every antenatal appointment and to any GP visits.

"Even if you think a condition isn't related to your pregnancy, it may turn out to be relevant," says midwife and Mother & Baby online expert Chris Salvage. In fact, it's worth taking your notes with you wherever you go – that way if you need medical attention while you are away from home, you'll have all the necessary information on hand.

What does it all mean?

Understanding your notes can be tricky, as medical jargon and abbreviations are used. Although antenatal notes vary slightly from one health area to another, we explain all the terms you're likely to come across.

The date of each antenatal visit.

Weeks or gestation

The length of your pregnancy in weeks, from the first day of your last monthly period (LMP).

Remember to take your antenatal notes to every antenatal appointment and to any GP visits.

Your weight is recorded at your first antenatal visit, but most clinics don't weigh you again.

Urinalysis (urine testing)

A urine sample will be tested at every antenatal visit for the following things:

• Sugar traces This may be a sign of gestational diabetes (diabetes in pregnancy). If sugar appears repeatedly, a blood test will be carried out.
• Albumin (Alb) This protein may be a sign of pre-eclampsia (a serious pregnancy condition affecting the placenta). Most women have a trace of protein in their urine at some time during their pregnancy. 'Although protein in the urine is fairly common, it should always be investigated,' says Chris Salvage.
• Ketones These chemicals are produced by your body when your fat-burning mechanisms aren't working properly. This may happen if you've got gestational diabetes, you're not eating enough, or you have pregnancy sickness.

If albumin or ketones are detected in your urine, the quantity is recorded with plus signs: + means a trace, ++ means more than a trace and +++ means a significant amount. You may also see the letters Tr, which means a small trace has been found. A tick, nil or NAD all mean the same – nothing abnormal found.

Understanding your notes can be tricky, as medical jargon and abbreviations are used.

Blood pressure

Your blood pressure will be written down as two numbers, one on top of the other, for example, 120/70. In pregnancy, a normal blood pressure range is between 95/60 and 135/85, but it's whatever is normal for you that's important. Your blood pressure will be measured at your booking-in visit and this figure will be used as your normal level, against which future readings will be compared.

Height of fundus (FH)

The fundus is the top of your uterus (womb). Your midwife will be able to feel where this is by pressing on your abdomen and will measure it from your pubic bone. Each centimetre roughly equates to a week of your baby's growth, and this figure will be put in your notes.

The 'lie' refers to the position of the crown of your baby's head (occiput) within your pelvis.

O (occiput) – this refers to the back of your baby's head, which could be facing:

• R – right
• L – left
• A (anterior) – to the front
• P (posterior) – to the back
• L (lateral) or T (transverse) – to the side

Presentation

The 'presentation' refers to which way up your baby is:

• C or Ceph (cephalic) or Vx (vertex) – head down
• Br (breech) – feet or bottom first

Relation of PP to brim

PP (presenting part) refers to the bit of your baby that will arrive first (usually the head). Your midwife will note down how much of your baby's head can be felt above the brim of your pelvis as fifths: 1/5 means it's starting to engage and 5/5 means it's fully engaged (your baby's head has moved into your pelvis ready to be born). E or Eng means engaged, while NE means not engaged.

Fetal heart

At around 12 weeks, your doctor or midwife will listen for your baby's heartbeat.

• FHH or H – fetal heart heard
• FHNH – fetal heart not heard – this isn't necessarily anything to worry about
• FMF – fetal movements have been felt

Although antenatal notes vary slightly from one health area to another, there are common terms you're likely to come across.

The medical term for swelling, which most commonly occurs in your feet, ankles or hands during pregnancy because your body retains more fluid. It can also be a sign of pre-eclampsia, so your midwife will always check this out.

This stands for haemoglobin, a substance found in red blood cells that carries oxygen around your body and to your baby. An essential ingredient of haemoglobin is iron. A blood test will determine your haemoglobin level – if it's low, you'll be prescribed iron supplements to raise it.

Remarks or notes

In this section, your midwife will record any other information such as the date booked for a scan (u/s or ultrasound), any further blood test you might need, or any medication you've been prescribed.

Did you know?

Within a few years, midwives and doctors will all be using standard antenatal notes. This means that if you move health authorities during your pregnancy you won't have to have a new set of notes made up.

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Your antenatal care

Antenatal care is the care you get from health professionals during your pregnancy.

It's sometimes called pregnancy care or maternity care.

You'll be offered appointments with a midwife, or sometimes a doctor who specialises in pregnancy and birth (an obstetrician).

You should start your antenatal care as soon as possible once you know you're pregnant. You can do this by contacting a midwife or GP, or referring yourself directly to maternity services near you. This is usually done by filling in an online form on your local hospital or NHS trust website.

What is antenatal care?

This is the care you receive while you're pregnant to make sure you and your baby are as well as possible.

The midwife or doctor providing your antenatal care will:

• check the health of you and your baby
• give you useful information to help you have a healthy pregnancy, including advice about  healthy eating and exercise
• discuss your options and choices for your care during pregnancy, labour and birth
• answer any questions you may have

If you’re pregnant in England you will be offered:

• 2  pregnancy ultrasound scans at 11 to 14 weeks and 18 to 21 weeks
• antenatal screening tests  to find out the chance of your baby having certain conditions, such as Down's syndrome
• blood tests to check for syphilis, HIV and hepatitis B
• screening for sickle cell and thalassaemia

You may also be offered antenatal classes , including breastfeeding workshops.

Ask your midwife about classes in your area.

Starting antenatal care

You can book an appointment with your GP or directly with a midwife as soon as you find out you're pregnant. You may be advised to refer yourself to your local maternity service to book your first appointment.

You can ask to be referred to your nearest midwifery service by your GP, midwife, healthcare professional, school nurse, community centre, children's centre or refugee hostel.

You can find your nearest children's centre through your local council .

It's best to see a midwife or GP as early as possible to get the information you need about having a healthy pregnancy.

Some tests, such as screening for sickle cell and thalassaemia , should be done before you're 10 weeks pregnant.

If you have special health needs, your midwife, GP or obstetrician may take shared responsibility for your maternity care.

This means they'll all be involved in your care during pregnancy.

Let your midwife know if you have a disability that means you have special requirements for your antenatal appointments or for labour.

If you do not speak English, tell your midwife.

How many antenatal appointments will I have?

If you're expecting your first child, you'll have up to 10 antenatal appointments.

If you have had a baby before, you'll have around 7 appointments, but sometimes you may have more – for example, if you develop a medical condition.

Early in your pregnancy, your midwife or doctor will give you written information about how many appointments you're likely to have and when they'll happen.

You should have a chance to discuss the  schedule of antenatal appointments with them.

If you cannot keep an appointment, let the clinic or midwife know and rearrange it.

Where will I have my antenatal appointments?

Your appointments can take place at:

• a Children's Centre
• a GP surgery

You'll usually go to the hospital for your pregnancy scans.

Antenatal appointments should take place in a setting where you feel able to discuss sensitive issues, such as domestic abuse, sexual abuse, mental health problems or drugs.

To make sure you get the best pregnancy care, your midwife will ask you many questions about your and your family's health, and your preferences.

Your midwife will carry out some antenatal checks and tests , some of which will be done throughout your pregnancy, such as urine tests and blood pressure checks.

The results may affect your choices later in pregnancy, so it's important not to miss them.

Your midwife will also ask about any other social care support you may have or need, such as support from social workers or family liaison officers.

Questions you might be asked

The midwife or doctor might ask about:

• the date of the first day of your last period
• your health
• any previous illnesses and operations you have had
• any previous pregnancies and  miscarriages
• the ethnic origins of you and your partner to find out whether your baby may be at risk of certain inherited conditions
• whether your family has a history of twins
• your job, your partner's job and what kind of accommodation you live in to see whether your circumstances might affect your pregnancy
• how you're feeling and whether you have been depressed

Your antenatal appointments are an opportunity to tell your midwife or doctor if you're in a vulnerable situation or if you need extra support.

This could be because of domestic abuse or violence , sexual abuse or female genital mutilation .

Antenatal appointments after 24 weeks

From around 24 weeks of your pregnancy , your antenatal appointments will usually become more frequent.

But if your pregnancy is uncomplicated and you're in good health, you may not be seen as often as someone who needs to be more closely monitored.

Later visits are usually quite short and may last 20 to 30 minutes.

Your midwife or doctor will: 

• check your urine and blood pressure
• feel your tummy (abdomen) to check the baby's position
• measure your womb (uterus) to check your baby's growth
• listen to your baby's heartbeat, if you want them to

You can also ask questions or talk about anything that's worrying you.

Talking about your feelings is as important as all the antenatal tests and examinations.

You should be given information about:

• making  your birth plan
• preparing for labour and birth
• how to tell if you're in active labour
• induction of labour  if your baby is overdue (after your expected date of delivery)
• feeling depressed after childbirth – such as the "baby blues" and postnatal depression
• feeding your baby
• vitamin K (given to prevent vitamin K deficiency bleeding in your baby)
• screening tests for newborn babies
• looking after yourself and your new baby

Find out about your schedule of antenatal appointments and what to expect at each one

At each antenatal appointment from 24 weeks of pregnancy, your midwife or doctor will check your baby's growth.

To do this, they'll measure the distance from the top of your womb to your pubic bone.

The measurement will be recorded in your notes.

Your baby's movements

Keep track of your baby's movements.

If you have not felt any movement by the time you are 24 weeks pregnant, contact your midwife who will check your baby’s heartbeat.

After 24 weeks, if your baby’s movements become less frequent, slow down or stop (called reduced foetal movement), contact your midwife or doctor immediately – do not wait until the next day. Your midwife or doctor will check you and your baby and measure your bump.

You'll be offered an ultrasound scan if they have any concerns about how your baby is growing and developing.

Find out more about your baby's movements in pregnancy .

Your maternity notes

At your booking appointment, your midwife will record your details and add to them at each appointment. These are your maternity notes.

Your maternity notes may be in a record book, sometimes called handheld notes. You’ll take your maternity notes home and be asked to bring them to all your antenatal appointments. Take your notes with you wherever you go in case you need medical attention while you’re away from home.

Your maternity notes may be electronic, which you will be able to access digitally.

You can ask your maternity team to explain anything in your notes that you do not understand.

Planning ahead for your appointments

Waiting times in clinics can vary and having to wait a long time for an appointment can be particularly difficult if you have young children with you.

Planning ahead can make your visits easier.

Here are some suggestions: 

• write a list of any questions you want to ask and take it with you
• make sure you get answers to your questions or the chance to discuss any worries
• if your partner is free, they may be able to go with you – this can help them feel more involved in the pregnancy
• you can buy refreshments in some clinics – take a snack with you if you cannot buy one at the clinic

The  National Institute for Health and Care Excellence (NICE) antenatal care guidelines  give useful information on the timing of visits during pregnancy and a description of what will happen each time.

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Page last reviewed: 13 November 2023 Next review due: 13 November 2026

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Welcome to preg.info

This site is maintained by the Perinatal Institute

We always welcome and gratefully receive comments, suggestions for improvements and alerts about new guidelines. If you would like to contribute to the consultation and review process, please contact the notes team to be added to the mailing list for consultations.

The notes are updated regularly according to national guidelines to represent the latest recommendations for best practice. They also allow consistent recording of information required for the new Maternity Payment System and the National Maternity Dataset.

Uptake has been increasing steadily across the NHS and currently already over 60% of pregnancies in England are being managed with the Pregnancy Notes. An electronic version of all maternity notes (MiApp) is currently being developed. For further details please see the link .

We recommend health professionals are trained to use the records prior to implementation into clinical practice. Examples of completed notes are available by clicking here . For information about training options or feedback please email: [email protected] .

UPDATE Measuring Continuity of Carer: A monitoring and evaluation framework was published October 2018 with the aim of helping Local Maternity Systems and the Maternity Transformation Programme to measure, consistently, the level of continuity of carer being provided over time and to help evaluate the extent to which particular models realise the benefits set out in the evidence.

What is meant by continuity of carer? It means each woman: -

There are 2 main models which meet these principles which Local Maternity Systems will want to consider for implementation locally:

Neither of the 2 models need to be operated in their pure forms and may be mixed.

Continuity levels will be monitored – the aim is to gain an understanding of the extent to which continuity if being delivered locally and nationally. This will be done in 3 ways: -

National Maternity Review – Better Births 2016 - For further information click here

Appointments at Mayo Clinic

• Pregnancy week by week
• Fetal presentation before birth

The way a baby is positioned in the uterus just before birth can have a big effect on labor and delivery. This positioning is called fetal presentation.

Babies twist, stretch and tumble quite a bit during pregnancy. Before labor starts, however, they usually come to rest in a way that allows them to be delivered through the birth canal headfirst. This position is called cephalic presentation. But there are other ways a baby may settle just before labor begins.

Following are some of the possible ways a baby may be positioned at the end of pregnancy.

Head down, face down

When a baby is head down, face down, the medical term for it is the cephalic occiput anterior position. This the most common position for a baby to be born in. With the face down and turned slightly to the side, the smallest part of the baby's head leads the way through the birth canal. It is the easiest way for a baby to be born.

Head down, face up

When a baby is head down, face up, the medical term for it is the cephalic occiput posterior position. In this position, it might be harder for a baby's head to go under the pubic bone during delivery. That can make labor take longer.

Most babies who begin labor in this position eventually turn to be face down. If that doesn't happen, and the second stage of labor is taking a long time, a member of the health care team may reach through the vagina to help the baby turn. This is called manual rotation.

In some cases, a baby can be born in the head-down, face-up position. Use of forceps or a vacuum device to help with delivery is more common when a baby is in this position than in the head-down, face-down position. In some cases, a C-section delivery may be needed.

Frank breech

When a baby's feet or buttocks are in place to come out first during birth, it's called a breech presentation. This happens in about 3% to 4% of babies close to the time of birth. The baby shown below is in a frank breech presentation. That's when the knees aren't bent, and the feet are close to the baby's head. This is the most common type of breech presentation.

If you are more than 36 weeks into your pregnancy and your baby is in a frank breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Most babies in a frank breech position are born by planned C-section.

Complete and incomplete breech

A complete breech presentation, as shown below, is when the baby has both knees bent and both legs pulled close to the body. In an incomplete breech, one or both of the legs are not pulled close to the body, and one or both of the feet or knees are below the baby's buttocks. If a baby is in either of these positions, you might feel kicking in the lower part of your belly.

If you are more than 36 weeks into your pregnancy and your baby is in a complete or incomplete breech presentation, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. It involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a breech position, talk with a member of your health care team about the choices you have for delivery. Many babies in a complete or incomplete breech position are born by planned C-section.

When a baby is sideways — lying horizontal across the uterus, rather than vertical — it's called a transverse lie. In this position, the baby's back might be:

• Down, with the back facing the birth canal.
• Sideways, with one shoulder pointing toward the birth canal.
• Up, with the hands and feet facing the birth canal.

Although many babies are sideways early in pregnancy, few stay this way when labor begins.

If your baby is in a transverse lie during week 37 of your pregnancy, your health care professional may try to move the baby into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of your health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

If the procedure isn't successful, or if the baby moves back into a transverse lie, talk with a member of your health care team about the choices you have for delivery. Many babies who are in a transverse lie are born by C-section.

If you're pregnant with twins and only the twin that's lower in the uterus is head down, as shown below, your health care provider may first deliver that baby vaginally.

Then, in some cases, your health care team may suggest delivering the second twin in the breech position. Or they may try to move the second twin into a head-down position. This is done using a procedure called external cephalic version. External cephalic version involves one or two members of the health care team putting pressure on your belly with their hands to get the baby to roll into a head-down position.

Your health care team may suggest delivery by C-section for the second twin if:

• An attempt to deliver the baby in the breech position is not successful.
• You do not want to try to have the baby delivered vaginally in the breech position.
• An attempt to move the baby into a head-down position is not successful.
• You do not want to try to move the baby to a head-down position.

In some cases, your health care team may advise that you have both twins delivered by C-section. That might happen if the lower twin is not head down, the second twin has low or high birth weight as compared to the first twin, or if preterm labor starts.

• Landon MB, et al., eds. Normal labor and delivery. In: Gabbe's Obstetrics: Normal and Problem Pregnancies. 8th ed. Elsevier; 2021. https://www.clinicalkey.com. Accessed May 19, 2023.
• Holcroft Argani C, et al. Occiput posterior position. https://www.updtodate.com/contents/search. Accessed May 19, 2023.
• Frequently asked questions: If your baby is breech. American College of Obstetricians and Gynecologists https://www.acog.org/womens-health/faqs/if-your-baby-is-breech. Accessed May 22, 2023.
• Hofmeyr GJ. Overview of breech presentation. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Strauss RA, et al. Transverse fetal lie. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Chasen ST, et al. Twin pregnancy: Labor and delivery. https://www.updtodate.com/contents/search. Accessed May 22, 2023.
• Cohen R, et al. Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins. The Journal of Maternal-Fetal & Neonatal Medicine. 2021; doi:10.1080/14767058.2021.2005569.
• Marnach ML (expert opinion). Mayo Clinic. May 31, 2023.

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Maternity notes abbreviations

What does everything mean?

What do all the abbreviations mean on my maternity notes?

Your maternity notes make for interesting reading and although most of them should be a pretty straightforward record of your appointments and the pregnancy screening tests you have had, you might find some abbreviations hard to decipher

At a glance

• Most maternity notes are a record of your appointments
• There are lots of common abbreviations which will be used throughout your pregnancy
• By the end of your pregnancy you will probably be a pro at deciphering them all

You may find your maternity notes are digital now, electronic patient records (EPRs) or digital maternity notes. Whether you are offered digital maternity notes may depend on which NHS trust your hospital is in. There is ongoing work nationally on The Womens Digital Care Records Project which supports women with the opportunity to contribute towards their own record. However many women will still have handheld maternity notes or a combination of handheld notes and digital records and will still be exposed to the common abbreviations used.

Although you should always clarify anything you don't understand in your notes with your midwife, here are the most common abbreviations you are likely to come across while you are pregnant – and most importantly, what they actually mean!

Alb: Albumin. A protein in your wee that could be a marker of a potential problem

BP: Blood pressure

Breech: Bottom down

Cephalic or ceph: head down (nearest to the symphysis pubis)

CGC: Customised growth chart – the chart used to plot the growth of your baby based on ultrasound scans and/or SFH measurements

EDD: Expected date of delivery

Eng: Engagement – when your baby's head has moved down in to your pelvis

FH: Foetal heart (your baby's heart)

FHH: Foetal heart heard

FHHR: Foetal heart heard and regular

FMF: Foetal movement felt  

Fundus: The top of your womb

GTT: Glucose Tolerance Test – a test used to check for gestational diabetes

Hb: Haemoglobin – the oxygen carrying part of your red blood cells 

Lie: Which way the baby is lying (either longitundinal; lengthwise, oblique (on an angle) or transverse (sideways)

LMP: Last menstrual period

MSU: Midstream urine

NAD: No abnormality detected (meaning there is nothing wrong)

NE: Not engaged (meaning your baby's head is not yet down in the pelvis)

NIPT: Non Invasive Prenatal testing

SFH : Symphysis fundal Height or standardised fundal height measurement, the measuring of your bump from the top of your uterus (fundus) to the top of your symphysis pubis which starts from 26 -28 weeks

Oedema: Swelling, usually of the hands of feet, and caused by fluid retention 

Presentation: Which part of the baby presents towards the birth canal

Sugar: The levels of sugar in your blood or urine 

Tr: Trace, so 'Tr blood' would mean a trace of blood was found in your urine, for instance

TCA: To come again (as in, you need another appointment)

USS: Ultrasound Scan

VE: Vaginal examination 

You might come across other abbreviations in your maternity notes, depending on any individual tests or screenings that you have – remember though, always ask for an explanation of any terminology you are not familiar with or do not understand.

Check with your midwife if there is anything on your notes that you don't understand

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• Mammary Glands
• Fallopian Tubes
• Supporting Ligaments
• Reproductive System
• Gametogenesis
• Placental Development
• Maternal Adaptations
• Menstrual Cycle
• Antenatal Care
• Small for Gestational Age
• Large for Gestational Age
• RBC Isoimmunisation
• Prematurity
• Prolonged Pregnancy
• Multiple Pregnancy
• Miscarriage
• Recurrent Miscarriage
• Ectopic Pregnancy
• Hyperemesis Gravidarum
• Gestational Trophoblastic Disease
• Breech Presentation
• Abnormal lie, Malpresentation and Malposition
• Oligohydramnios
• Polyhydramnios
• Placenta Praevia
• Placental Abruption
• Pre-Eclampsia
• Gestational Diabetes
• Headaches in Pregnancy
• Haematological
• Obstetric Cholestasis
• Thyroid Disease in Pregnancy
• Epilepsy in Pregnancy
• Induction of Labour
• Operative Vaginal Delivery
• Prelabour Rupture of Membranes
• Caesarean Section
• Shoulder Dystocia
• Cord Prolapse
• Uterine Rupture
• Amniotic Fluid Embolism
• Primary PPH
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• Obstetric History
• Gynaecological History
• Sexual History

Obstetric Examination

• Speculum Examination
• Bimanual Examination
• Amniocentesis
• Chorionic Villus Sampling
• Hysterectomy
• Endometrial Ablation
• Tension-Free Vaginal Tape
• Contraceptive Implant
• Fitting an IUS or IUD

Original Author(s): Minesh Mistry Last updated: 12th November 2018 Revisions: 7

• 1 Introduction
• 2 Preparation
• 3 General Inspection
• 4 Abdominal Inspection
• 5.1 Fundal Height
• 5.3 Presentation
• 5.4 Liquor Volume
• 5.5 Engagement
• 6 Fetal Auscultation
• 7 Completing the Examination

The obstetric examination is a type of abdominal examination performed in pregnancy.

It is unique in the fact that the clinician is simultaneously trying to assess the health of two individuals – the mother and the fetus.

In this article, we shall look at how to perform an obstetric examination in an OSCE-style setting.

Introduction

• Introduce yourself to the patient
• Wash your hands
• Explain to the patient what the examination involves and why it is necessary
• Obtain verbal consent

Preparation

• In the UK, this is performed at the booking appointment, and is not routinely recommended at subsequent visits
• Patient should have an empty bladder
• Cover above and below where appropriate
• Ask the patient to lie in the supine position with the head of the bed raised to 15 degrees
• Prepare your equipment: measuring tape, pinnard stethoscope or doppler transducer, ultrasound gel

General Inspection

• General wellbeing – at ease or distressed by physical pain.
• Hands – palpate the radial pulse.
• Head and neck – melasma, conjunctival pallor, jaundice, oedema.
• Legs and feet – calf swelling, oedema and varicose veins.

Abdominal Inspection

In the obstetric examination, inspect the abdomen for:

• Distension compatible with pregnancy
• Fetal movement (>24 weeks)
• Surgical scars – previous Caesarean section, laproscopic port scars
• Skin changes indicative of pregnancy – linea nigra (dark vertical line from umbilicus to the pubis), striae gravidarum (‘stretch marks’), striae albicans (old, silvery-white striae)

Fig 1 – Skin changes in pregnancy. A) Linea nigra. B) Striae gravidarum and albicans.

Ask the patient to comment on any tenderness and observe her facial and verbal responses throughout. Note any guarding.

Fundal Height

• Use the medial edge of the left hand to press down at the xiphisternum, working downwards to locate the fundus.
• Measure from here to the pubic symphysis in both cm and inches. Turn the measuring tape so that the numbers face the abdomen (to avoid bias in your measurements).
• Uterus should be palpable after 12 weeks, near the umbilicus at 20 weeks and near the xiphisternum at 36 weeks (these measurements are often slightly different if the woman is tall or short).
• The distance should be similar to gestational age in weeks (+/- 2 cm).
• Facing the patient’s head, place hands on either side of the top of the uterus and gently apply pressure
• Move the hands and palpate down the abdomen
• One side will feel fuller and firmer – this is the back. Fetal limbs may be palpable on the opposing side

Fig 2 – Assessing fetal lie and presentation.

Presentation

• Palpate the lower uterus (below the umbilicus) to find the presenting part.
• Firm and round signifies cephalic, soft and/or non-round suggests breech. If breech presentation is suspected, the fetal head can be often be palpated in the upper uterus.
• Ballot head by pushing it gently from one side to the other.

Liquor Volume

• Palpate and ballot fluid to approximate volume to determine if there is oligohydraminos/polyhydramnios
• When assessing the lie, only feeling fetal parts on deep palpation suggests large amounts of fluid
• Fetal engagement refers to whether the presenting part has entered the bony pelvis
• Note how much of the head is palpable – if the entire head is palpable, the fetus is unengaged.
• Engagement is measured in 1/5s

Fig 3 – Assessing fetal engagement.

Fetal Auscultation

• Hand-held Doppler machine >16 weeks (trying before this gestation often leads to anxiety if the heart cannot be auscultated).
• Pinard stethoscope over the anterior shoulder >28 weeks
• Feel the mother’s pulse at the same time
• Should be 110-160bpm (>24 weeks)

Completing the Examination

• Palpate the ankles for oedema and test for hyperreflexia (pre-eclampsia)
• Thank the patient and allow them to dress in private
• Summarise findings
• Blood pressure
• Urine dipstick
• Hands - palpate the radial pulse.
• Skin changes indicative of pregnancy - linea nigra (dark vertical line from umbilicus to the pubis), striae gravidarum ('stretch marks'), striae albicans (old, silvery-white striae)
• One side will feel fuller and firmer - this is the back. Fetal limbs may be palpable on the opposing side

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