ABDOMINAL EXAMINATION / PALPATION

Aims
1. ■Observe the signs of pregnancy and parity ■Assess the fetal size and growth ■Detect deviations from the normal ■ Locate the fetal parts to indicate position and presentation ■Auscultate the fetal heart
Equipment
1. ■Doptone ■Aqueous gel ■Non-stretching tape measure ■Wedge as required
Preparation
1. 1.1 Perform hand hygiene before and after patient contact.
  1. 1.2 Explain the procedure and gain permission to proceed.
    1. 1.3 Encourage the woman to empty her bladder prior to the procedure.
      1. 1.4 Position the woman in the semi recumbent dorsal position on the bed. Consider placing a wedge under the right buttock if the gravid uterus is of a size likely to compromise maternal and/or fetal circulation.
        1.5 Ensure the woman is appropriately covered.
        The woman’s modesty and privacy is respected.
        The woman should be encouraged to lie with her arms by her sides to aid relaxation of the abdominal muscles. Pelvic tilt prevents occurrence of supine hypotension resulting from the weight of the gravid uterus obstructing the inferior vena cava – reducing venous return and hence cardiac output.
      2. A full bladder will make the examination uncomfortable and can reduce the accuracy of the fundal height measurement.
  2. Ensuring the practitioner has warm hands may reduce maternal discomfort and risk for causing contraction of the uterine or abdominal muscles.
Visual Inspection
1. 2.1 Note the abdominal size.
  1. 2.2 Observe the abdominal shape.
    1. 2.3 Inspect the abdomen for scars.
      1. 2.4 Examine the skin.
        2.5 Observe for fetal movements.
        Hormonal influences in pregnancy can cause striae gravidarum, hyper-pigmentation, changes in nails, hair, and the vascular system. Striae gravidarum caused by physical and hormonal influences is more common in younger women, those with higher body mass indices, and in women carrying larger babies. Daily massage may prevent stretch marks, however there is no evidence to indicate the use of which creams, emollients and oils prevent occurrence.
      2. Presence of scars may indicate previous abdominal or obstetric surgery.
    2. An abdominal shape that is longer than it is wide indicates a longitudinal lie. However, a shape that is low and broad may point to a transverse lie. The primigravid uterus is ovoid in shape compared to the multigravid uterus, which is a rounded shape. Dips and curves in the uterus may indicate fetal position.
  2. A full bladder, distended colon, or maternal obesity may effect estimation of fetal size.
Estimating gestation age
1. 3.1 Palpate of the abdomen by using the physical landmarks of the xiphisternum, the umbilicus and the symphysis pubis.
  1. 3.2 Measure the fundal height with the tape measure. See Clinical Guideline, Section B 1.6.3 Measuring the Fundal Height with a Tape Measure.
    1. Between 20 to 34 weeks gestation the height of the uterus correlates closely with measurements in centimetres, however obesity has been shown to distort the accuracy of these measurements
  2. Macrosomia, multiple pregnancy and small for gestation age may be detected by palpation and measurement of fundal height. Current evidence does not indicate that either the palpation method, or measurement of fundal height method, is superior to each other for detection of abnormal fetal growth. If a small for gestational age fetus is suspected, then confirmation of the estimated gestational age should be revisited.
4 Palpation Summary
1. 4.1 Fundal Palpation
  1. Both hands are gently placed around the fundus to determine contours of the fetus.
    1. This aids determination of presentation, whether cephalic or breech. This will aid diagnosis of the lie and presentation of the fetus.
2. 4.2 Lateral Palpation
  1. Hands are placed at umbilicus level on either side of the uterus. Gentle pressure is used with each hand to determine which side offers the greatest resistance. ‘Walking’ the fingers over the abdomen can also locate the position of the back and distinguish fetal body parts.
    1. Location of the fetal back can help determine the fetal position.
3. 4.3 Pelvic Palpation
  1. Ask the woman to bend her knees slightly and encourage gentle breathing exercises. So that A woman in a relaxed position is less likely to tense abdominal muscles.
    1. To confirm presentation and engagement the midwife: ■ faces towards the woman’s feet ■ places both hands on either side of the presenting ■ uterine pole and palpates gently starting at least 10cm ■ above the symphysis pubis moving downwards towards it. ■ identifies the level and side of the occiput and sinciput ■ when the presentation is vertex. In a normal vertex ■ presentation the head is flexed and the sinciput will be ■ palpated at a higher level than the occiput. Assess engagement of the presenting part of the fetus (defined as no more than 2/5ths palpable above the pelvic brim).

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ABDOMINAL EXAMINATION / PALPATION

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