Abdominal Examination Theory Flashcards
What are the aims of abdominal examination?
- observe the signs of preg
- assess fetal growth, size, wellbeing, presentation and position
- detect deviations from the norm - refer for scan (2nd opinion)
When is an abdominal examination carried out?
- every antenatal appointment post 24 weeks gestation
- prior to auscultation of fetal heart (16+ weeks)
- before VE - check baby’s wellbeing - movement, heart rate
- throughout labour - check contractions and dilation
When would you NOT do an abdominal examination?
- placental abruption - separating from the lining of the uterus happening too soon
- pre-term labour - don’t want to speed things up further
What are the 3 stages of an abdominal examination procedure?
1 - Inspection
2 - Palpation
3 - Auscultation
What are you ‘inspecting’ for in the first stage of an examination?
- Skin - linea nigra, striae gravidarium
2 - Shape - might indicate fetal position or presentation
3 - Scars - note abdominal scares, previous surgery, corresponds to medical history
4 - Size - consider maternal obesity, previous pregnancies, fetal size and lie, gestation
What are the 3 stages of the ‘palpation’ stage of an examination?
- fundal palpation
- pelvic palpation
- lateral palpation
Explain the ‘fundal palpation’?
to assess the estimated gestation by assessing fundal height and suggest an indication of lie and presentation
Explain the ‘pelvic palpation’?
confirm fetal presentation and engagement (measured in 1/5s).
Explain the ‘lateral palpation’?
assess the main body of uterus to identify fetal position and confirm lie, uterine volume, fetal movements and amniotic fluid volume
What does it mean to ‘auscultate’ in the 3rd stage of examination?
listen to fetal heart beat with sonicaid and/or pinard
During ‘inspection’ what are the Four ‘S’s?
- Skin - linea nigra, striae gravidarium
2 - Shape - might indicate fetal position or presentation
3 - Scars - note abdominal scares, previous surgery, corresponds to medical history
4 - Size - consider maternal obesity, previous pregnancies, fetal size and lie, gestation
State the procedure for abdominal examination (10)
- establish fetal wellbeing
- gain consent
- gather equipment (pinard, sonicaid, gel, tissue, notes)
- mother empty bladder
- semi-recumbent position
- midwife wash hands
- expose abdomen and inspect 4S’s
- fundal palpation, measurement, lateral palpation, pelvic palpation
- auscultate fetal heart
- documentation
What factor might influence fundal heigh measurement?
- inaccurate dates (LMP)
- fetal growth
- amniotic fluid volume
- multiple pregnancy
- raised BMI
- abnormal fetal lie
- uterine mass
- poor measuring technique
- intrauterine death
What is meant by ‘lie’? What 3 types of lie is there?
The relationship of the long axis of the fetus to the long axis of the uterus
- longitudinal
- transverse
- oblique
Define the ‘presentation’? What 5 types of presentation is there?
The part of the fetus that is in the lowest point of the uterus
- cephalic - head first, chin to chest
- breech - bottom first
- face - face up
- brow - forehead, chin extended from chest
- shoulder - emergency section
Define ‘position’
The position is the relationship of the denominator to sex point on the pelvic brim
Explain the ‘denominator’ in relation to fetal ‘position’
The denominator is the part of the presentation which is used when referring to fetal position - the denominator for a vertex presentation is the occiput
List the options for positions in a vertex presentation
Left occipitoanterior (LOA) Right occipitoanterior (ROA) Left occipitolateral (LOL) Right occipitolateral (ROL) Left occipitoposterior (LOP) Right occipitoposterior (ROP) Direct occipitoanterior (DOA) - middle, back to belly Direct occipitoposterior (DOP) - middle, back to back
Define ‘vertex’
centre of head in cephalic presentation, where the 3 lines meet
Define ‘engagement’
the transverse diameter of the fetal skull has passed the brim of the pelvis. Measured in fifths palpable.
What is the fetal heart assessed for?
- presence
- rate (110-160bpm)
- regularity
- no decelerations
- acceleration = sign of wellbeing and movement
- check maternal pulse at same time
What procedure must you follow post examination?
- communicate findings and offer explanations to woman
- recognise deviations from the norm
- referrals where necessary
- reassurance
- document findings
