Abdominal Examination

Question 1

Aims of an abdominal examination is:

Answer 1

To assess fetal wellbeing and growth at that time.

From 36 weeks helps to establish lie, presentation and position to assist with birth planning.

Question 2

Lie

Answer 2

Relationship of the long axis of the fetus to the long axis of the uterus

Question 3

Position

Answer 3

The relationship of the denominator to one of the 6/8 points of the pelvis

Question 4

Abdominal examinations are performed:

Answer 4

At each antenatal appointment after 24-5 weeks as recommended by NICE guidelines 2014.
On admission to hospital, triage for labour or any reason.
Prior to any procedure - VE, before CTG, before auscultation.
Throughout labour.

Question 5

Preparation of client:

Answer 5

First wash hands and read notes.
Explain procedure and gain consent.
Ensure privacy and dignity.
Encourage to empty bladder.
Semi recumbent position.
Equipment - pinard, tape measure, watch with second hand.

Question 6

Inspection:

You examine the…

Answer 6

Shape - multiparus is rouser due to less muscle tone, nuliparus is more ovoid. Help with determination fetal position.
Linea nigra
Striae gravidarium
Fetal movements

Question 7

Symphysis fundal height measurement is done to…

Answer 7

Asses growth of the fetus, performed after 24/5 weeks but not plotted until 26 as recommended by NICE guidelines 2014.

Tape measure upside down at highest point of the fund is to symphisis pubis bone.

Plotted on customised growth chart.

Question 8

Fundal palpating is used to…

Answer 8

Identify fetal pole, buttocks or head at the top of the fundus (buttocks softer, head harder)
Pole not identified = not longitudinal lie

Question 9

Lateral palpating is used to…

Answer 9

Asses the main body of the uterus to identify fetal position and lie.
Spine firmer, limbs protruding.
Uterterine tone may become harder during a contraction.
Mother must be aware of regular fetal movements and that if they change to get checked out.
Position not relevant till 36 weeks.

Question 10

Pelvic palpating is used to…

Answer 10

Confirm presentation and engagement of the presenting part.
This should only be carried out after 36 weeks as is very uncomfortable.

The head engages after 36 weeks for nuliparous women but can be at the onset of labour for multiparous women

Question 11

Engagement

Answer 11

When the widest diameter of the presenting part moved down through the pelvic brim

Question 12

Presentation

Answer 12

The part of the fetus lying in the lower part of the uterus

Question 13

Auscultation is…

Answer 13

Listening to the fetal heart either with a sonic aid or pinard.

Question 14

Why is auscultation done:

Answer 14

To reassure the mother and indication of fetal wellbeing.
The clearest sounds are heard through the back of the fetal shoulder.
Assessed for presence and rate 110-160.

Not a requirement for antenatal appointments - NICE 2014

Question 15

Auscultation should be done…

Answer 15

Every 15 mins when in labour

Every 5 mins or after a contraction in 2nd stage

Question 16

All findings should be…

Answer 16

Discussed with the mother and my mentor and documented in notes, writing should be legible, signed and dated and counter signed by midwife.

Fetal moment importance stressed and concerns escalated to midwife or doctor.