Pregnant Abdomen Examination Flashcards
What is the following sign and what may it suggest?
Jaundice: a yellowish or greenish pigmentation of the skin and whites of the eyes due to high bilirubin levels (e.g. obstetric cholestasis).
What is the following sign and what may it suggest?
Oedema: a small amount of oedema is normal in the later stages of pregnancy however if there is widespread oedema affecting the arms, legs and face consider the possibility of pre-eclampsia.
What is Obstetric cholestasis?
Obstetric cholestasis
Obstetric cholestasis is a multifactorial condition that is characterised by abnormal liver function tests, jaundice and intense pruritis (typically affecting the palms and soles of the feet). The disease usually presents in the third trimester and is associated with an increased risk of intrauterine death and premature delivery.
What is the following clinical sign and what does it indicate?
Melasma: benign dark and irregular hyperpigmented macules which are normal in pregnancy.
When should fetal movements be visible?
Fetal movements: these are typically visible from 24 weeks gestation.
What is the following clinical sign and what does it indicate?
Linea nigra: a dark line running vertically down the middle of the abdomen (a normal finding in pregnancy).
What is the following clinical sign and what does it indicate?
Striae gravidarum: reddish or purple lesions that develop due to overstretching of the abdominal skin as the gravid uterus expands (commonly referred to as stretch marks)
What is the following clinical sign and what does it indicate?
Striae albicans: mature stretch marks which appear silver-like in colour and are less pronounced.
What is Aortocaval compression syndrome?
Aortocaval compression syndrome occurs due to compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman is supine. Aortocaval compression can result in maternal hypotension, loss of consciousness and in rare cases fetal demise. Women in late pregnancy are positioned in the left lateral position when supine to reduce pressure on the aorta and inferior vena cava.
Where should the uterine fundus be found during pregnancy, depending on the patient’s current gestation:
12 weeks gestation
20 weeks gestation
36 weeks gestation
Palpate the uterus to identify its borders, including the upper and lateral edges.
The uterine fundus can be found at different locations during pregnancy, depending on the patient’s current gestation:
12 weeks gestation: pubic symphysis
20 weeks gestation: umbilicus
36 weeks gestation: the xiphoid process of the sternum
What are different types of fetal lie?
Types of fetal lie
There are three main types of fetal lie which include:
Longitudinal lie: the head and buttocks are palpable at each end of the uterus.
Oblique lie: the head and buttocks are palpable in one of the iliac fossae.
Transverse lie: the fetus is lying directly across the uterus.
What are the different types of fetal presentation?
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).
How would you describe fetal engagement?
The fetal head is divided into fifths when assessing engagement:
If you are able to feel the entire head in the abdomen, it is five fifths palpable (i.e. not engaged).
If you are not able to feel the head at all abdominally, it is zero fifths palpable (i.e. fully engaged).
What is Symphyseal-fundal height and how does it correlate with gestational age?
Symphyseal-fundal height is the distance between the fundus and the upper border of the pubic symphysis. After 20 weeks gestation, the symphyseal-fundal height should correlate with the gestational age of the fetus in weeks (+/- 2cm).
What further investigations/ examinations would you like to do?
Assessment of the fetal heartbeat: using a Pinard stethoscope or Doppler ultrasound.
Blood pressure measurement: to assess for evidence of hypertension (e.g. pre-eclampsia).
Urinalysis: to assess for evidence of proteinuria (pre-eclampsia) and urinary tract infection.
Speculum examination: if there are concerns about vaginal bleeding or premature rupture of membranes.
Weight and height measurement
Ultrasound scan: to assess the position and wellbeing of the fetus.
