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Midwifery Practice 1 Exam > Abdominal Examination > Flashcards

Abdominal Examination Flashcards

1
Q

Define Abdominal Examination

A

According to skills for midwifery practice, it’s a skill used to assess fetal growth during pregnancy to determine presentation, position and lie as pregnancy processes

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2
Q

Why do we carry out abdominal examination?

A

To observe signs of pregnancy
Assess fetal growth, size and wellbeing
Locate fetal parts, position and presentation
Detect deviations from the norm

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3
Q

When would we carry out abdominal examination?

A

At each antenatal assessment. NICE 2008 state from 24 weeks gestation
Prior to auscultation of fetal heart and use of CTG equipment
Before vaginal examination
Throughout labour

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4
Q

Which women would we need to be cautious when carrying out abdominal examination?

A

Experienced placental abruption and preterm labour

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5
Q

What are the 3 Stages of abdominal examination?

A

Inspection-visually looking
Palpation-fundal, lateral, pelvic
Auscultation-listen to fetal heart rate

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6
Q

What do we look for during inspection?

A

Skin - any linea nigra, striae gravidum, skin irritation, surgery scars, bruising

Size - obesity, multiple pregnancy, poly or oligohydramnious, fetal size

Fetal movements - visible, is movement normal, can u feel movement, maternal concerns

Shape - indicate position or presentation

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7
Q

Explain how you would measure fundal height

A
  1. Obtain consent in line with NMC code
  2. Identify fund us by fundal palpation
  3. Use non elastic tape measure with cms facing down
  4. Measure from top of fund us to symphysis pubis
  5. Should only be measured once
  6. Record results
  7. Refer on if concerned
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8
Q

Why might inconsistencies occur when measuring fundal height?

A 
Unreliable landmarks
More/ less amniotic fluid than expected 
Fetid larger/ smaller than expected 
Uterine mass
Intrauterine death 
Multiple pregnancy 
Abnormal lie
Poor technique 
Inaccurate dates
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9
Q

Why do we carry out fundal palpation?

A

Skills for midwifery practice state it is undertaken to determine the presentation
Which pole is in the upper part of uterus

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10
Q

What is fundul palpation influenced by?

A

Parity
Size of woman
Full bladder
Whether baby is in a transverse lie

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11
Q

What does it mean if pole cannot be felt?

A

Fetus is likely to be in a transverse lie

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12
Q

Explain the procedure for fundal palpation

A
  1. Obtain informed consent in line with NMC code
  2. Face with the woman to assess signs of discomfort
  3. Place hands on top of fundus just below the xiphisternum
  4. Once felt the palmer sided of fingers of both hands are placed either side of fund us and gently palpate apply pressure
  5. Identify the pole
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13
Q

How would you know you have identified the head?

A

The head feels firm, rounded and ballotable

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14
Q

How would you know you’ve identified the buttocks?

A

Less firm, larger mass, less ballotoble, less clearly defined

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15
Q

Define lie and the three different types

A

The long axis of fetal spine in relation to long axis of mothers uterus

Longitudinal
Transverse
Oblique

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16
Q

Why is lateral palpation carried out?

A

According to skills for midwifery practice, it is undertaken to determine the position of fetus and confirm the lie

17
Q

What does lateral palpation tell us?

A

The size
Tone
Fluid volume
Fetal movements

18
Q

Define what position means

A

Relationship of the denominator to 6 areas on the maternal pelvis
Further defined as maternal left or right

19
Q

What is the denominator if it is cephalic?

A

Occiput

20
Q

What is the denominator if the presentation is breeched?

A

Sacrum

21
Q

If baby is positioned on the maternal left facing inwards in a cephalic presentation, what is the position?

A

Left occiputanterior

22
Q

Why is pelvic palpation undertaken?

A

To determine the presentation, whether the fetus is flexed or extended and whether presenting part has engaged

23
Q

What is the presenting part?

A

Anatomical part of fetus that is leading directly over cervix

24
Q

What are the five types of presenting part?

A 
Breech
Face 
Brow 
Shoulder 
Vertex
25
Q

What is meant by engagement?

A

Relationship between the presenting part and the brim of maternal pelvis
It is assessed according to the passage of the widest transverse diameter through pelvic brim

26
Q

How would you describe it if it is not engaged?

A

Free

27
Q

How would you pelvic palpate?

A

Using both hands and fingers facing your feet, press in gently

28
Q

What is the attitude?

A

Relationship of the fetal head and limbs to its body

29
Q

What is a fully flexed position?

A

Chin and limbs tucked

30
Q

What is a poorly flexed position?

A

Chin and limbs untucked

31
Q

What is an extended attitude?

A

chin up and limbs untucked

32
Q

What is auscultation?

A

Listening for the fetal heart rate

33
Q

When would you auscultate the fetal heart rate?

A

Prior to application of CTG equipment
Throughout labour to monitor fetus response to labour
Determine fetal life in the event of absence of fetal movements
Upon maternal request

34
Q

Where are the clearest sounds heard?

A

In the baby’s scapula

35
Q

How would you know where to place equipment?

A

By locating the presentation and position

36
Q

What are we assessing during auscultation?

A

Presence
Rate 110-160bpm
Regularity
Variability

37
Q

Explain the procedure when using a pinard stethoscope

A
  1. Obtain consent in line with NMC code and begin palpation
  2. Place pinard over area of sounds expected
  3. Remove hand so ear, pinard and abdomen are in direct contact
  4. Listen and count FH for 1 min
  5. Discuss findings with mother
  6. Document and act accordingly
38
Q

Explain the procedure when using a sonicaid

A
  1. Obtain consent in line with the NMC code and begin palpation
  2. Listen with pinard
  3. Lubricate probe with conductive gel
  4. Count heart rate for 1 minute
  5. Reassure other sounds may be heard eg. uterine blood flow, fetal movements, placenta
  6. Wipe off gel
  7. Discuss findings with mother
  8. Document and act accordingly

Midwifery Practice 1 Exam (8 decks)

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