Clinical/Comm Skills - Week 3 - Antenatal Abdominal Examination Flashcards
Normally in the booking examination, an obstetrics history is taken before the abdominal exmaiantion is carried out, and blood pressure What are the key points of the obstetrics history?
Name, age and parity PC and HPC - systemic enquiry History of present pregnancy Past obstetrcis history Gynaecological history PMH and previous surgeries DHx and allergies FHx SHx
What are important questions to ask in the history of presenting complaint in a pregnant woman?
Any nasuea or vomiting - hyperemesis gravidarum Any abdominal pain Vaginal bleeding or clots Dysuria / urinary frequency Fatigue - ie anaemia Headaches/visual changes/swelling - pre-eclampsia
IN the antenatal examination of the pregnant women, an abdominal examination is carried out (video here - https://medblogs.dundee.ac.uk/reproduction-sip/teaching-materials/antenatal-examination-video/) What should the woman do prior to the examiantion?
Empty their bladder - can take MSSU here for urinalysis
What position should the patient be in for the abdominal examaintion? What is different about the position in the third trimester?
The patient should be slightly elevated - patient should be at a 30 degrees (particularly in the third trimester) to left lateral tilt to allow adequate venous return - the uterus can compress on the vena cava in pregnant women
To begin with, inspection is carried out Why are scars looked for?
Scars and striae (stretch marks) Foetal movements may also be seen
In roughly three quarters of all pregnancies a black line appears running from just above the umbilicus to the pubic symphysis What is this brown pigmented line known as? How long does this brown pigmented line last for?
This line is known as the linea nigra Lasts for roughly 6 weeks after the pregnancy Linea nigra is due to increased melanocyte-stimulating hormone made by the placenta,[3] which also causes melasma and darkened nipples.
What are the key things looked for on inspection?
Scars - position/location Striae gravidarum Linea nigra Excess fluid - polyhydramnios or LAck of fluid - oligohydramnios
What is measured after the inspection? How is the measurement carried out?
The fundal symphyseal length is measured - from fundus of the uterus to pubic symphsysi - provides an estimation of gestational age to determine growth of bfoetus Take a normal measuring tape - find 0 then flip it over so you cannot see the cm - remember this measure is to confirm foetal growth and therefore if you could see the cm - maybe you would adjust the tape
How many weeks of gestation is the fundal symphyseal height measurement usually within?
Most measurements (in cm) are usually within 2 weeks of gestational age
How many weeks pregnant for the fundys of the uterus to reach: Palpation out of the pelvis? Midway between pubic bone and umbilicus? The umbilicus? Midway between xiphisternum and umbilucus? The xiphisternum?
Uterus remains a pelvic organ until 12 weeks. From this stage onward the uterus may be palpated abdominally.
Midway between pubic bone and umbilicus - roughly 16 weeks Umbilicus - ~ 20 weeks
Midway between umbilicus & xiphistenum -~30 wks Xiphisternum - ~ 36 weeks
The next part of the examination uses leopold’s manoevure What is the object of leopolds manoevure in the abdominal examiantion?
This manoevure determines the foetal lie, the foetal position and any engagement of the foetal head in the mothers pelvis
What are the three different types of foetal lie? What is the foetal lie in reference to?
The lie is the relation of the longitudinal axis of the foetus to the longitudinal axis of the uterus Can be longitudinal lie, oblique lie or transverse lie
When is the transverse lie of the foetus mostly seen?
This is mostly seen in woman who have had several babies
After determining the foetal lie, the foetal position is determined next - the relation of the denominator of the presenting part of the foetus in relation to the quadrants of the maternal pelvis - start at the pelvis end The side that the foetus is lying on is also determined by putting one hand on one side and walking the other hand down on the other side of the abdomen What does the more lumpy side indicate?
This indicates foetal limbs - smooth side indicates spine
The denominator of the foetal position can be * Vertex * Breech or * Face What is the other word for each of these?
* Vertex - cocciput * Breech - sacrum * Face - mentum The words anterior, psoterior and transverse for the foetal psotion all refer to the position of which the occiput, sacrum or face (depending on the position of the foetus) will exit the pelvis Ie Left occipital anterior - means baby is on its left side, with occiput exiting pelvis first and in the anterior aspect of the mother (pubic bone)
Name the foetal positions - from left to right of each row Top row - vertex - occipital Middle row - face - mentum Bottom row - breech - sacrum
Top - LOA, LOT, LOP Middle - RMA, RMT, RMP (mentum refers to where the chin is (anterior or posterior to the mother) Bottom- RSA, RST, RSP
The electronic doppler is placed in the exact same position as the pinard stethoscope would be WHat is the advantage of using the doppler?WHat does a normal foetal heart rate range from? It is important to also measure the maternal heart rate to make sure you have not mistaken the foetal heart rate
The advantage is that the mother can be reassured that she can hear her own babies heart (Routine Doppler ultrasound should not be used in low‑risk pregnancies.) A normal foetal heart rate ranges from 120-160 bpm
