Abdominal Palpation

Question 1

What are the indications for performing abdominal palpation (6 answers)

Answer 1

1. Antenatal Clinic
2. Antenatal ward admission
3. Prior to amniocentesis or other invasive screening test
4. Prior to auscultation of FH and use of CTG equipment
5. Prior to a vaginal examination
6. Labour

Question 2

What are some points to consider prior to undertaking palpation? (9 in total)

Answer 2

1. Infection control – wash hands, before and
   after the procedure
2. Knowledge of medical / obstetric history
3. Explanations about the procedure / Informed consent
4. Dignity/privacy/comfort - abdomen only exposed to an extent that permits a thorough examination
5. Women should be semi-recumbent
6. Bladder should be empty
7. Arms by side – as relaxed as possible
8. Warm hands - Uterus can be stimulated during the procedure
9. Assessment by same person can reduce errors (particularly when measuring fundal height)

Question 3

What does IFLAPPED stand for?

Answer 3

I - Inspection 
F - Fundus
L - Lie 
A - Attitude 
P - Position
P - Presentation 
E - Engagement 
D - Denominator

Question 4

When inspecting an abdomen, what are you looking for?

Answer 4

Skin – linea nigra, striae gravidarum (stretch marks)
surgery, skin irritation, bruising

Size – obesity, lax abdominal muscles,
multiple pregnancy, polyhydramnious (too much fluid) and oligohydramnious (too little fluid), fetal size, fibroids, growth restriction/macrosomia and gestation period.

Fetal movements - are they visible? Have an awareness of maternal concerns.

Shape – may indicate position or
presentation eg. “dip” for Occipital
Posterior position.

Question 5

Where is the fundal height measured?

Answer 5

From top of the fundus to the symphysis pubis

Question 6

What are the three types of lie, and what do they look like?

Answer 6

Longitudinal - straight in line with the mothers body (most common)

Oblique - on an angle (slightly sideways)

Transverse - sideways

Question 7

What is the attitude, and what are the three types?

Answer 7

The relationship of the fetal head to its body. They can affect the presenting fetal skull diameter during intrapartum.
Fully flexed - Chin tucked in to shoulders, curved back
Poorly flexed - Not tucked in, straight back
Extended - Head tilted back

Question 8

What is the definition of position, and what are the possible positions (assuming cephalic presentation)?

Answer 8

The position is the relation of the denominator of the fetal skull to the six areas of the pelvis. The 6 positions are:

ROP - Right occipitoposterior (back facing mums back, right side)
ROT - Right occipitotransverse (back facing mums right side)
ROA - Right occipitoanterior (back facing mums stomach, right side)
LOP - Left occipitoposterior (back facing mums back, left side)
LOT - Left occipitotransverse (back facing mums left side)
LOA - Left occipitoanterior (back facing mums stomach, left side)
OA - Back is directly facing outwards (not slightly sideways)
OP- Back is directly facing mother’s back (not slightly sideways)

Question 9

What is fetal presentation? What are some examples of fetal presentation?

Answer 9

The anatomical part of the fetus which is leading/The part of the baby that will be the first to deliver.

Examples: 
Cephalic/vertex
Brow
Face
Breech

Question 10

What is engagement and how is it measured?

Answer 10

The relationship between the presenting part and the brim of the maternal pelvis, measured in 5ths and by palpating above the symphysis pubis, for example, if the head is 3/5 engaged, only 2/5 is palpable

Question 11

What is the denominator and what are the landmarks for a cephalic, breech and face presentation?

Answer 11

The landmark determining what position the baby is in.
Cephalic: Occiput (back of fetal head)
Breech: Sacrum/buttocks
Face: Mentum (chin)

Question 12

What are the risks of abdominal palpation?

Answer 12

If a woman is lay semi-recumbent for too long, it may compress the vena cava which supplied the uterus with blood
May be uncomfortable for the woman, particularly when palpating to determine the engagement

Question 13

What is auscultation and what are we looking for?

Answer 13

Auscultation is the act of listening to the fetal heart rate (FHR) through a sonicaid and/or a pinard.
We are looking for: 
Presence
Rate 110 – 160bpm
Regularity
Variability

Question 14

How long should we perform auscultation for?

Answer 14

1 minute

Question 15

What are the three stages of palpation?

Answer 15

Fundal
Lateral
Pelvic

Question 16

How would you undertake fundal palpation?

Answer 16

(Ensure hands are washed and informed consent obtained)
Place hands on abdomen, below xiphisternum and move gently down until firmness of fundus felt.
Use palmar surface both hands to palpate and identify pole (usually fetal head or buttocks)

These manoeuvres are part of Leopolds manoeuvres.

Question 17

How would you undertake lateral palpation?

Answer 17

Use one hand to support the uterus at level of umbilicus while other hand palpates and progresses down the length of uterus on the other side. Repeat on opposite side.
These manoeuvres are part of Leopolds manoeuvres.

Question 18

How would you undertake pelvic palpation?

Answer 18

Using both hands with your fingers facing the woman’s feet, press in gently – it is helpful for women to take deep breath and hold. This is called Pawlik’s manoeuvre.