Examination Per Abdomen Flashcards
What are the aims of an EPA (examination per abdomen)?
- Observe the signs of pregnancy
- Assess fetal size and growth
- Auscultate the fetal heart when indicated
- Locate fetal parts
- Detect any divination from normal
What are the 4 steps to an EPA?
1) Preparation
2) Inspection
3) Palpation
4) Auscultation
What happens during the preparation stage of an EPA?
Must talk to mum and explain what it is you would like to do (an EPA) and check she is okay for you to go ahead. If so….
- check if her bladder is empty, ‘have you had a wee recently’ she must have an empty bladder. Full bladder will make the examination uncomfortable and will make the fundal height measurement less accurate
- ensure you have all of your equipment ready and it is all of working order.
- ask mum to get on the couch (couch should be set up in semi recumbent position)and make her self comfy.
- ensure mums privacy is kept are all doors shut and windows that expose her covered appropriately?
- wash your hands thoroughly.
- ask if she has felt baby move?
- explain the steps you will follow.
- before you go ahead check that she gives consent again “are you okay for me to go ahead?”.
What happens during the inspection of an EPA?
- typiacally the shape of the uterus is more long then it is broad, if the uterus appears more broad then long and it is low then the baby may be transverse.
- if there is a dip at mums umbilicus then the foetus may be in an occipitoposterior position ether LOP, ROP or direct OP.
- we observe for fetal movements in this time this may help us if finding the position of the foetus.
- we look for skin changes such as stretch marks old (silver) and new (pink), a linea nigra, signs of previous abdominal surgery, and the presence of rashes or itching.
- we also look for signs of domestic abuse (bruising may be observed)
What are the 4 steps in an EPA?
- Fundal height measurement
- Fundal palpation
- Lateral palpation
- Pelvic palpation
How do you carry out the measurement of the fundal height?
Step one of an EPA
To locate the fundus we have to place our hands just be;pow the xphisternum.
- pressing gently we move our hands down the abdomen until we feel a curved upper border of the fundus.
- from 25 weeks a symphysis fundal height measurement should be carried out to help assess uterine size.
- a tape measure is used with the cm facing the mothers abdomen. It is held at the fundus and extended down to the symphysis pubis
- this measurement should be recorded in the pregnancy record and on the customised GROW chart
What is indicated if the fundal height is higher then expected?
- Dates may be inaccurate
- The foetus is larger then expected
- The amount of amniotic fluid may be greater (polyhydramnios)
- The woman may have had multiple pregnancies
- uterine mass such as tumour, cyst or fibroid
- poor technique
What is indicated if the fundal height is shorter then expected?
- Dates may be inaccurate
- The foetus may be smaller then expected
- The amount of amniotic fluid may be less (Oligohydramnios)
- the lie may be abnormal (transverse)
- Poor technique
- Intrauterine death
How do you carry out a fundal palpation?
Step two of an EPA?
- Lay both hands on top of the fundus- fingers held close together and curving round the upper body of the uterus
- Gentle yet deliberate pressure must be applied to help determine the outline .
- sometime buttocks feel firm however they are not as hard, smooth or well defined as the head
- using gliding movements finger tips can should separate to grasp the fetal mass. The breech cannot be moved independently of the body but the head can
- the head can be balloted (moved from hand to hand)due to the free movement of the neck.
- If no pole is felt at the fundus either the buttocks or the head then the foetus is most likely transverse
How do you carry out a lateral palpation?
Step three of an EPA
- hands are placed either side of the uterus level with the umbilicus
- Gentle pressure is applied to either side of the uterus in order to see which side has more resistance (this is the back, as it is smooth and firm)
- the side that is less regularly defined and feels softer is the side where the lion side lay.
Another method to do this is to ‘walk ‘ their fingertips across the uterus from side to side from the fundus to the symphysis pubis
How do you carry out a pelvic palpation?
- must only be done from 36 weeks
- woman needs to bend her knees and relax
- the sides of the uterus below the umbilicus level must be grasped snugly between the palms of hands with fingers held close together, pointing downwards and inwards
- if the head is presenting a hard mass with a distinctive round smooth surface will be felt
- during this we must feel how much of the fetal head is palpable above the pelvic brim to determine engagement
- the two handed technique is much more comfortable for women and gloves the most information
What is engagement of the fetal head?
This is said to have occurred when the widest presenting transverse diameter of the fetal head has passed through the brim of the pelvis
- this can occur any time from 36 weeks
What is presentation?
Presentation refers to the part of the foetus that lies at the pelvic brim or in the lower pole of the uterus presentations can be
- vertex head is flexed✅
- breech❌
- shoulder❌
- face head is fully extended ❌
-brow head is partially exten❌
It is more common for the head to present because the bulky breech has more room nearer the fundus (widest diameter of the uterus)
What is a position?
This is the relationship between the denominator of the presentation (normally the head) and the 6 points of the pelvic brim these are: LOA ROA Direct OA LOP ROP Direct OP
What is lie?
This is the relationship between the long axis of the foetus and the long axis of the uterus
Majority are longitudinal
The remainder are either oblique (diagonally) or transverse (horizontally)
