Abdominal Examination

Question 1

Palpatation

Answer 1

examination by touch- assess position, growth and wellbeing of child

Question 2

presentation

Answer 2

the part of the bany that lies at the woman’s pelvic brim / in the pelvis

Question 3

cephalic

Answer 3

(presentation of baby) - head in the pelvis

Question 4

breech

Answer 4

(Type of presentation)- bottom in pelvis

Question 5

fundus

Answer 5

highest part of the uterus

Question 6

presentation

Answer 6

the part of the fetus lying in the lower segment of the uterus, at or within the pelvic brim

Question 7

lie

Answer 7

the relationship between the spine of the baby, and the spine of mum
- longitudinal, oblique, transverse

Question 8

fundal height

Answer 8

distance from pubic symphysis to the highest part of the uterus

Question 9

longitudinal

Answer 9

lie (baby is longitudinal to mum’s body)

can be cephalic or breech

Question 10

Obique

Answer 10

type of lie.

Question 11

Transverse

Answer 11

type of lie.

Question 12

denominator

Answer 12

a landmark on the presentation that helps you describe how much the baby has rotated

Question 13

presenting part

Answer 13

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

Question 14

attitude

Answer 14

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

Question 15

position

Answer 15

relationship between the denominator and 8 points on the pelvic brim
Left Occipitoanterior
Right Occipitolateral

Question 16

<p>auscultation</p>

Answer 16

<p>listening to sounds (i.e. fetal heart auscultation)</p>

Question 17

<p>FHR</p>

Answer 17

<p>Fetal heart rate</p>

Question 18

<p>bpm</p>

Answer 18

<p>beats per minute</p>

Question 19

what is normal FHR

Answer 19

<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>

Question 20

doppler

Answer 20

<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>

Question 21

<p>EFM / CEFM</p>

Answer 21

<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>

Question 22

IA

Answer 22

<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>

Question 23

<p>UA</p>

Answer 23

<p>Uterine activity (e.g. frequency, duration and strength of contractions), resting tone, any uterine irritability or tenderness</p>

Question 24

<p>1Pinard / fetoscope</p>

Answer 24

<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>