Abdominal Examination Flashcards
Define Abdominal Examination
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
Why do we carry out abdominal examination?
To observe signs of pregnancy
Assess fetal growth, size and wellbeing
Locate fetal parts, position and presentation
Detect deviations from the norm
When would we carry out abdominal examination?
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
Which women would we need to be cautious when carrying out abdominal examination?
Experienced placental abruption and preterm labour
What are the 3 Stages of abdominal examination?
Inspection-visually looking
Palpation-fundal, lateral, pelvic
Auscultation-listen to fetal heart rate
What do we look for during inspection?
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
Explain how you would measure fundal height
- Obtain consent in line with NMC code
- Identify fund us by fundal palpation
- Use non elastic tape measure with cms facing down
- Measure from top of fund us to symphysis pubis
- Should only be measured once
- Record results
- Refer on if concerned
Why might inconsistencies occur when measuring fundal height?
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
Why do we carry out fundal palpation?
Skills for midwifery practice state it is undertaken to determine the presentation
Which pole is in the upper part of uterus
What is fundul palpation influenced by?
Parity
Size of woman
Full bladder
Whether baby is in a transverse lie
What does it mean if pole cannot be felt?
Fetus is likely to be in a transverse lie
Explain the procedure for fundal palpation
- Obtain informed consent in line with NMC code
- Face with the woman to assess signs of discomfort
- Place hands on top of fundus just below the xiphisternum
- Once felt the palmer sided of fingers of both hands are placed either side of fund us and gently palpate apply pressure
- Identify the pole
How would you know you have identified the head?
The head feels firm, rounded and ballotable
How would you know you’ve identified the buttocks?
Less firm, larger mass, less ballotoble, less clearly defined
Define lie and the three different types
The long axis of fetal spine in relation to long axis of mothers uterus
Longitudinal
Transverse
Oblique
Why is lateral palpation carried out?
According to skills for midwifery practice, it is undertaken to determine the position of fetus and confirm the lie
What does lateral palpation tell us?
The size
Tone
Fluid volume
Fetal movements
Define what position means
Relationship of the denominator to 6 areas on the maternal pelvis
Further defined as maternal left or right
What is the denominator if it is cephalic?
Occiput
What is the denominator if the presentation is breeched?
Sacrum
If baby is positioned on the maternal left facing inwards in a cephalic presentation, what is the position?
Left occiputanterior
Why is pelvic palpation undertaken?
To determine the presentation, whether the fetus is flexed or extended and whether presenting part has engaged
What is the presenting part?
Anatomical part of fetus that is leading directly over cervix
What are the five types of presenting part?
Breech Face Brow Shoulder Vertex
What is meant by engagement?
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
How would you describe it if it is not engaged?
Free
How would you pelvic palpate?
Using both hands and fingers facing your feet, press in gently
What is the attitude?
Relationship of the fetal head and limbs to its body
What is a fully flexed position?
Chin and limbs tucked
What is a poorly flexed position?
Chin and limbs untucked
What is an extended attitude?
chin up and limbs untucked
What is auscultation?
Listening for the fetal heart rate
When would you auscultate the fetal heart rate?
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
Where are the clearest sounds heard?
In the baby’s scapula
How would you know where to place equipment?
By locating the presentation and position
What are we assessing during auscultation?
Presence
Rate 110-160bpm
Regularity
Variability
Explain the procedure when using a pinard stethoscope
- Obtain consent in line with NMC code and begin palpation
- Place pinard over area of sounds expected
- Remove hand so ear, pinard and abdomen are in direct contact
- Listen and count FH for 1 min
- Discuss findings with mother
- Document and act accordingly
Explain the procedure when using a sonicaid
- Obtain consent in line with the NMC code and begin palpation
- Listen with pinard
- Lubricate probe with conductive gel
- Count heart rate for 1 minute
- Reassure other sounds may be heard eg. uterine blood flow, fetal movements, placenta
- Wipe off gel
- Discuss findings with mother
- Document and act accordingly
