Pregnant Abdomen Examination

Question 1

General Inspection

Answer 1

Any discomfort, systemically well
Eyes - anaemia or jaundice
Pulse

(BP, urine dip)
Check gestation using obstetric dating wheel and last menstrual period

Question 2

Abdomen Inspection

Answer 2

Look for abdominal distension in keeping with pregnancy
Convex - occipito-anterior foetal position
Concave -occipito-posterior foetal position

Foetal movements
Scars - pfannenstiel (c section), laparotomy (ruptured ectopic, ovarian mass removal)
Cutaneous signs of pregnancy
- Linea nigra - dark line from xiohisternum to pubis
- striae gravidarium - purple striae
- striae albicans - silvery white striae (previous parity)
- umbilical inversion - increased intraadominal pressure
- dilated superficial veins - collateral flow due to pressure on IVC from gravid uterus

Question 3

Fundal height

Answer 3

Start palpation at xiphisternum with flat of hand (palpable from 12 weeks, reaches umbilicus at 20 weeks)
Move down abdomen in central line until fundus located
Measure from here to pubic symphysis
Tape measure should be face down to avoid bias

Question 4

Foetal lie and presentation

Answer 4

Use both hands, each side of uterus
Watch patients face throughout
Apply gentle pressure with left hand, with right feel for firm, curved fetal back or lumpy foetal limbs (swap hands)
Which side is the back?

Establish lie of foetus - longitudinal, transverse
Presentation - decide if firm round and narrow (head = cephalic presentation) or soft and broad (bottom = breech presentation)

Question 5

Engagement

Answer 5

Not applicable if breech

Check if presentation goes part is freely mobile or if more fixed suggests engagement
Approximate how many finger breadths needed to cover head above pelvic brim
1 finger = 1 fifth

Question 6

Estimate liquor volume

Answer 6

Foetal parts should be palpable but if all easily palpable, this may suggest reduction in liquor volume

Question 7

Auscultation

Answer 7

Consider lie and place stethoscope on anterior shoulder
Doppler - adjust until clear heart beat heard (norm = 120 - 140)
Check radial pulse at same time to confirm foetal not maternal
Listen for 1minute

Question 8

Legs

Answer 8

Peripheral oedema (pre-eclampsia)