Abdominal Examination Flashcards
Palpatation
examination by touch- assess position, growth and wellbeing of child
presentation
the part of the bany that lies at the woman’s pelvic brim / in the pelvis
cephalic
(presentation of baby) - head in the pelvis
breech
(Type of presentation)- bottom in pelvis
fundus
highest part of the uterus
presentation
the part of the fetus lying in the lower segment of the uterus, at or within the pelvic brim
lie
the relationship between the spine of the baby, and the spine of mum
- longitudinal, oblique, transverse
fundal height
distance from pubic symphysis to the highest part of the uterus
longitudinal
lie (baby is longitudinal to mum’s body)
can be cephalic or breech
Obique
type of lie.
Transverse
type of lie.
denominator
a landmark on the presentation that helps you describe how much the baby has rotated
presenting part
the part of the body that lies closest to the cervix - i.e. what the fingers contact first during an internal exam.
more specific than presentation-
- vertex / face/ brow/ foot/ sacrum / shoulder / cord
attitude
relationship of the baby’s head and limbs to it’s trunk (degree of flexion / extension)
fully flexed (chin on chest) has smallest diameter, enabling optimal descent through woman's pelvis. assessed by vaginal examination
position
relationship between the denominator and 8 points on the pelvic brim
Left Occipitoanterior
Right Occipitolateral
<p>auscultation</p>
<p>listening to sounds (i.e. fetal heart auscultation)</p>
<p>FHR</p>
<p>Fetal heart rate</p>
<p>bpm</p>
<p>beats per minute</p>
what is normal FHR
<p><strong>normal</strong></p>
<p>110-160 bpm Rhythm is regular Absence of FHR decreases (FHR normally increases with fetal movement and is considered reassuring)</p>
<p></p>
<p><strong>abnormal</strong></p>
<ul><li>FHR consistently >160 bpm (tachycardia) or <110 bpm (bradycardia)</li><li>average FHR is rising / rhythm is irregular / there are abrupt or gradual decreases in FHR</li></ul>
doppler
<p>Fetal doppler / Sonicaid</p>
<p>hand held - can be used for 12weeks gestation / mum can hear</p>
<p>FHR is heart as a rapid double tapping sound</p>
<p>EFM / CEFM</p>
<p>Electronic fetal monitoring / Continuous Electronic Fetal monitoring<br></br>CTG - can be used for reassurance if there are reduced fetal movements / post term pregnancy<br></br><br></br>CEFM is not recommended for well women with uncomplicated pregnancy as it's associated with increase in C section without known benefit to mama or pepe- admission CTG increases C section rate by ~20%</p>
IA
<p>Intermittant auscultation An active listening and counting method</p>
<p>(as opposed to CEFM- continuous electronic fetal monitoring, which provides visual assessment of a printed trace)</p>
<p><strong>recommended FHR frequency </strong>(but this is negotiated with wahine and dependent on her condition)</p>
<ul><li>pre-labour- as part of palpation</li><li>active labour- first stage- auscultate every 15-30mins</li><li>active second stage - auscultate at least every 5mins (or after every contraction)</li></ul>
<p><strong>may also do additional auscultation-</strong></p>
<ul><li>spontaneous rupture of the membranes (SRM)</li><li>Vaginal exam (VE)</li><li>Artificial rupture of membranes (ARM)</li></ul>
<p>UA</p>
<p>Uterine activity (e.g. frequency, duration and strength of contractions), resting tone, any uterine irritability or tenderness</p>
<p>1Pinard / fetoscope</p>
<p><strong>pinard- like a horn. fetoscope- 2 ears</strong></p>
<p>benefits-</p>
<ul><li>low tech</li><li>enables midwife to hear actual sounds (doppler is translating frequency into sound, so you're listening to machine's interpretation- so there can be mistaken pick ups)</li><li>requires more sensitivity and specificity from midwife (pinard has to be in correct location, thus helps confirm the pepes lie)</li></ul>
