Abdominal Palpation (W/S 3) Flashcards
What are the 3 parts of abdominal palpation?
- Inspection
- Palpation - fundal, lateral, pelvic
- Auscultation
What to look for during an abdominal palpation inspection? (8)
- Size - equal to dates?
- Shape - ovoid (first baby?), round (subsequent baby?)
- Pigmentation - linea nigra
- Striae gravidarum - polyhydramnios, multiple pregnancy
- Scars - LSCS, laparoscopy
- Fetal movements
- Bruising
- Piercings
What is involved in the palpation part of an abdominal palpation?
- Palpate fundal height (using ulna border of hand above fundus)
- Measure fundal height (from highest point of fetal pole/fundus to highest point of pubic bone/symphysis pubis, following the lie of the baby)
- Fundal palpation to locate fetal pole
- Lateral palpation to determine lie, position and attitude
- Pelvic palpation to determine presentation and engagement
What are fundal height landmarks at 12, 16, 24, 30, 40 weeks?
12 - just above symphysis pubis
16 - midway between symphysis pubis and umbilicus
24 - at umbilicus
30 - midway between breasts and umbilicus
40 - xiphisternum for multipara, below for primigravida (because non engagement of presenting part in multiparous women until labour starts - more relaxed muscles)
Why might fundal height be greater than expected? (5)
- Inaccurate dates
- Polyhydramnios / increased amniotic fluid volume
- GDM
- Large baby
- Multiple pregnancy
Why might there be discrepancies in fundal height? (8)
- Oligohydramnios (low amniotic fluid volume)
- Polyhydramnios (excessive AF volume)
- Inaccurate dates
- Multiple pregnancy
- Large for dates
- Fetal deaths
- Intra-uterine growth restriction
- Uterine fibroids
How would you determine between a fetal head and a breech found in the fundus?
Fetal head in the fundus is rounder and harder, feels tender to the woman, is ballotable (head nods and whole body does not move)
Fetal buttocks is not as round and hard. It’s a broader, indefinite mass, whole body moves side to side when breech is moved.
What is meant by presentation? What are examples of presentations?
The part of the fetus lying in the lower pole of the uterus. Which part of the fetus is coming first.
Cephalic/vertex Brow Face Sacrum (Breech) Shoulder
What is the attitude for a cephalic presentation?
Flexed
What is the attitude for a brow presentation?
Deflexed
What is the attitude for a face presentation?
Extended
What is the attitude for a shoulder presentation?
Flexed
What is meant by attitude?
The relationship of the fetal head and limbs to the body.
Whether the fetus is flexed (limbs tight to body) or not
What is meant by lie? What are the types of lie?
The relationship between the long axis of the baby and the long axis of the mother. Where is the long axis of the baby in comparison to the long axis of the woman?
Lie is how the fetus is lying compared to the spine of the woman.
Longitudinal
Oblique
Transverse
What is meant by denominator?
The name give to the part of the presentation to help us describe / denotes position.
What is meant by position?
Position is where the denominator is within the woman’s pelvis.
What is meant by engagement?
Engagement describes when the widest part of the presenting part is through the brim of the pelvis.
How do you conduct the lateral palpation and what are you feeling for?
Hold one side of the uterus and feel down the other. Is there a smooth broad resistance? Back. Or small irregular parts? Limbs.
When presentation is vertex/cephalic what is the denominator?
Occiput
When presentation is breech what is the denominator?
Sacrum
When presentation is face what is the denominator?
Mentum
What can be relationship of the denominator to the areas of the pelvis?
Left or right
Posterior, lateral or anterior
Direct- occiput are very front or back of pelvis
What is meant by engagement?
The widest diameter of the presenting part has moved below the brim of the pelvis.
The amount of head descended into the pelvis.
What does engagement 5/5 above the brim mean?
Head is completely above the pelvic brim.
Can get fingers around top of head.
What does engagement 4/5 above the brim mean?
Sinciput high, occiput easily felt
What does engagement 3/5 above the brim mean?
Sinciput easily felt, occiput felt
What does engagement 2/5 above the brim mean?
Sinciput felt, occiput just felt
What does engagement 1/5 above the brim mean?
Sinciput felt, occiput not felt
What does engagement 0/5 above the brim mean?
None of head palpable
In a vertex presentation, if you can palpate 3/5 or more above the brim, is it engaged or not engaged?
Not engaged
In a vertex presentation, if you can palpate 3/5 or more above the brim, is it engaged or not engaged?
Not engaged
In a vertex presentation, if you can palpate 3/5 or more above the brim, is it engaged or not engaged?
Not engaged
On pelvic palpation if you can feel more sinciput on one side, the attitude is…
Flexed
On pelvic palpation if you can feel equal amounts of sinciput on both sides, the attitude is…
Deflexed
What is the normal fetal heart rate range?
110-160 bpm
Auscultation can occur using….
A fetoscope
A pinard stethoscope
A doptone / Doppler/ sonicaid
Fetal heart rate is heard through…
The fetal back
During auscultation, always check what simultaneously?
Maternal pulse - to avoid documenting a fetal death, may be high due to infection
What needs to be considered or completed before conducting an abdominal palpation?
Wash hands.
Safety- what has the woman been through?
Privacy - will she feel exposed? Close curtain, shut door, cover underwear
Comfort - empty bladder? Warm enough?
Language - does she speak English and understand
Left tilt from 28 weeks, wedge under right hip
Until how many weeks do you use clinical judgement according to landmarks to assess fundal height?
24
At how many weeks do you use a tape measure to measure fundal height?
24-28
Fundal height is useful in screening for:
Small or large for gestational age
Oligohydramnios and polyhydramnios
Fundal height =
weeks gestation +/- 2cm
