Pregnant abdomen

Question 1

How would you introduce for the pregnant abdomen examination?

Answer 1

Introduce yourself
Confirm pt’s full name and DOB

Explain that you are going to have a look at their tummy and feel their tummy. You are going to assess baby’s position and heartbeat, and take some measurements.

Requires pt to expose their abdomen.

Wash hands

Ask mother:
- how many weeks pregnant are you?
- are you in any pain?
- do you need to empty your bladder before I continue examining you?

Then tell pt to lie on the bed 30-45deg.

Question 2

What are you observing for when inspecting the abdomen?

Answer 2

Scars
Previous caesarean section scars
Obvious fetal movement (>24weeks)

Skin changes:
- linea nigra (dark vertical line)
- striae gravidarum (red/purple stretch marks)
- striae albicans (silvery white striae)

Question 3

What are you assessing for during palpation of the pregnant abdomen?

Answer 3

Fundal height (>20weeks)
- measure from fundus to symphysis pubis

Lie (>20weeks)
- feel for baby’s head, bottom, back
- this assesses for baby’s position

Presentation
- feel the lower uterus and the position of the baby -cephalic or breech presentation

Question 4

How do you palpate to measure fundal height?

Answer 4

Fundal height (>20weeks)
- palpate for the fundus (top part of the uterus/womb) using medial edge of left hand from the
xiphisternum down to locate fundus

• then measure from the fundus to the symphysis pubis and record the number (make sure tape faces down so that you can’t see the number)

Question 5

How do you palpate to assess lie of the baby?

Answer 5

1. Place your hands on either side of the patient’s uterus (ensuring you are facing the patient).
2. Gently palpate each side of the uterus:

One side of the uterus should feel full in nature (due to the presence of the fetal back).

On the other side of the uterus, you may be able to feel the fetus’s limbs.

Question 6

How do you palpate to assess the fetal presentation?

Answer 6

1. Ensure you are facing the patient to observe for signs of discomfort and warn the patient this may feel a little uncomfortable.
2. Place your hands either side of the lower pole of the uterus, just above the pubic symphysis.
3. Apply firm pressure to the uterus angled medially, palpating for the presenting part:

A hard round presenting part is suggestive of a cephalic presentation (normal).
A broader, softer, less defined presenting part (i.e. the fetal bottom or legs) is suggestive of a breech presentation (abnormal).

Question 7

How do you auscultate the fetal heart?

Answer 7

Identify the fetus back.
Put the doppler US probe or Pinard stethoscope between baby’s shoulder
Listen for one minute and record this.

Question 8

Before you complete the examination, what else would you measure and/or palpate for?

Answer 8

Ankle oedema (signs of pre-eclampsia)

Blood pressure

Urine dipstick