Abdominal Palpation

Question 1

What are the aims of abdominal palpation?

Answer 1

• Assess foetal size and growth, through SFH from 24/40
• Assess foetal presentation at/after 36/40
• Auscultate the foetal heart
• Detect deviations from normal

Question 2

How should the midwife prepare for the procedure?

Answer 2

• Ask woman to empty bladder
• Assemble equipment
• Observe and listen to the woman
• Informed consent
• Promote privacy and dignity
• Wash hands

Question 3

What are the main components of the examination?

Answer 3

Observe abdomen and then assess:
- location of fundus
- foetal growth (SFH)
- foetal lie
- foetal presentation
- engagement of presenting part
and document all findings

Question 4

What should be observed on the woman’s abdomen?

Answer 4

• Size of bump
• Shape of bump
• Notable skin changes
• Foetal movements
• Evidence of previous scars or signs of domestic violence

Question 5

Why should the woman not lie flat?

Answer 5

Puts pressure on major blood vessels

Question 6

Name some of the skin changes that may be observed

Answer 6

• Linea nigra
• Striae gravidarum (stretch marks)
• Rashes
• Infections (e.g. chicken pox)
• Polyhydramnios (enlarged abdomen - excess fluid)

Question 7

What does a dip at the umbilicus indicate?

Answer 7

Occipitoposterior position

Question 8

If the woman is complaining of back pain, what may this indicate?

Answer 8

Occipitoposterior baby (back to back)

Question 9

What is the technique for assessing the uterine fundus?

Answer 9

Using the hand nearest the woman, the pads of the fingers are placed on the abdomen below the xiphisternum and moved gently downwards until the firmness of the curved upper border of the fundus is felt

Question 10

How should the SFH be measured?

Answer 10

• 24/40 onwards
• Use tape measure and secure at fundus with 1 hand
• Measure from top of fundus to top of SP
• Measure once only
• Discuss and document findings

Question 11

Define the term ‘lie’

Answer 11

The axis of the baby in relation to the maternal spine/ relationship between long axis of foetus and long axis of uterus

• Longitudinal
• Oblique
• Transverse

Question 12

Define the term ‘presentation’

Answer 12

Which part is showing at the pelvis

• Cephalic/ Vertex (head)
• Sacrum/ Breech (bottom)
• Face
• Brow
• Shoulder

Question 13

Define the term ‘position’

Answer 13

How the presentation is lying

• Right OP etc
• Right/ left refers to woman’s right/left, not our perspective

Question 14

How should foetal presentation be assessed?

Answer 14

1. Fundal palpation
2. Lateral palpation
3. Pelvic palpation

Question 15

Why is SFH measured?

Answer 15

• SFH possible indicator of foetal growth

- Poor foetal growth is a cause of serious perinatal mortality and morbidity

Question 16

Why is foetal presentation assessed?

Answer 16

• Assists with foetal HR auscultation

- May determine mode of birth

Question 17

What is engagement of the presenting part?

Answer 17

• Occurs when widest presenting transverse diameter of presenting part has passed through pelvic brim
• In primips, this occurs at any time from 36/40
• In multipara, the head may not engage until as late and the onset of labour
• Engagement measures in 5ths palpable above pelvic brim

Question 18

What is the denominator?

Answer 18

The name of the part of the presentation which is used when referring to foetal position

• Cephalic presentation = occiput
• Breech presentation = sacrum
• Face presentation = mentum