From the 36 week onwards, it is essential to assess the pelvic capacity in every pregnant woman. In a normal pelvic brim inclination of 600 the head should engage from 36 week, but in some African women with pelvic inclination of over 80 the head does not engage until labour has been in progress for some hours.
1. Sitting the patient up.
Ensure that the bladder is empty while patient lies on the couch, grasp the fetal head with the right hand as in pawlik’s grip. Rest the ulna border of the examining hand, with the 4th and last fingers on the symphysis pubis. The woman is asked to sit up without assistant and to lean forwards for a short time. Her diaphragm and abdominal muscles tend to press the fetus downwards. The thumb, index and middle fingers feel the head go through the pelvis. Any overlap (which is suggestive of cephalo – pelvic disproportion will be felt by the fingers on the symphysis pubis)
2. With the Patient Standing: Let the patient stand up with herfeet slightly apart. Face her and grasp fetal head gently. Let her lean forward slightly holding the edge of the couch with both hands. Push the head backward and downward gently. The titled pelvis makes the entry through the pelvic brim ‘direct’ in the absence of cephalo -pelvic disproportion.