Abdominal Palpation

Question 1

Aim of Abdominal Palpation

Answer 1

• To assess foetal growth, size, position, presentation, lie, attitude and well-being
• Auscultate foetal heart
• To detect deviations from normal

Question 2

Leopold’s Manouvres

Answer 2

Systematic approach to abdominal palpation to determine foetal lie, presentation and attitude

Question 3

Indications

Answer 3

• Each antenatal assessment, particularly after 24 weeks
• On admission to hospital
• Prior to auscultation of foetal heart and use of CTG equipment
• Prior to VE
• Throughout Labour

Question 4

Contraindications

Answer 4

As it can stimulate the uterus, caution required when:

• Placenta abruption
• Preterm labour

Question 5

Principles

Answer 5

• Overall Assessment of Mother first - look & listen
• Informed consent
• Maintain privacy and dignity
• Mother’s comfort
• Documentation
• Discussion

Question 6

Technique

Answer 6

• Inspection (Size, shape, skin changes, foetal movements may be seen)
• Palpation (fundal, lateral and pelvic)
• Ausculatation

Question 7

Inspection

Answer 7

• Size (affected by obesity, lax abdominal muscles, multiple pregnancy, poly and oligohydramnios, foetal size and lie, gestation)
• Shape (may give an indication of foetal position/presentation)
• Skin changes (linea nigra, striae gravidarum, signs of previous abdominal surgery)
• Foetal movements may be seen

Question 8

Fundal Palpation

Answer 8

• Assess estimated gestation

- Indicator of lie and identification of pole suspected presentation of the foetus confirmed

Question 9

Fundal Height Inconsistent with Gestation may Indicate

Answer 9

• Unreliable landmarks
• Inaccurate dates
• Foetus larger or smaller than expected
• More or less amniotic fluid than expected
• Multiple Pregnancy
• Abnormal Lie
• Uterine Mass
• Poor technique
• Intrauterine Death

Question 10

Identifying the Pole

Answer 10

• Buttocks: Softer, Bulkier, Less Ballotable
• Head: Rounder, Firmer, Ballotable
• Pole located in fundus means a longitudinal line

Question 11

Lateral Palpation

Answer 11

• Identifies foetal position and confirms lie (usually longitudinal, can be oblique or transverse)
• The spine is usually firmer and smoother
• Limbs are less regularly defined
• The lie of the foetus is determined by the relationship of the long axis of the foetal spine to the long axis of the material uterus

Question 12

Pelvic Palpation

Answer 12

• Assesses presentation
• Flexion
• Engagement
• Five main presentations:
  ~ Vertex
  ~ Brow
  ~ Face
  ~ Breech
  ~ Shoulder

Question 13

Engagement

Answer 13

Engagement is defines as the point when the engaging diameter goes past the pelvic brim

Question 14

Fundal Height

Answer 14

• Reflects the progression of foetal growth
• To measure fundal height, use a tape measure to gauge length from the notch of the symphisis pubis to the top of the funds, centimetres equals approximate weeks gestation after 20 weeks.

Question 15

Foetal Heart Rate

Answer 15

• Ranges from 110-160 beats per minutes when auscultating for one minute
• Can detect as early as ten weeks gestation with doppler. Listen midline of the woman’s abdomen above the pubic hairline.
• After 20 weeks gestation palpate for foetal back using Leopold’s manoeuvres. Listen over foetal thorax or back (scapula)
• Foetal Heart Rate should be auscultated and counted for one minute while simultaneously counting maternal pulse

Question 16

Foetal Heart Rate Auscultation

Answer 16

• Pinard can be used from 24 weeks gestation, is a learned and practised skill
• Dopple can be used earlier than pinard, and the mother can also hear the FHR