Abdominal Examination Theory

Question 1

What are the aims of abdominal examination?

Answer 1

• observe the signs of preg
• assess fetal growth, size, wellbeing, presentation and position
• detect deviations from the norm - refer for scan (2nd opinion)

Question 2

When is an abdominal examination carried out?

Answer 2

• every antenatal appointment post 24 weeks gestation
• prior to auscultation of fetal heart (16+ weeks)
• before VE - check baby’s wellbeing - movement, heart rate
• throughout labour - check contractions and dilation

Question 3

When would you NOT do an abdominal examination?

Answer 3

• placental abruption - separating from the lining of the uterus happening too soon
• pre-term labour - don’t want to speed things up further

Question 4

What are the 3 stages of an abdominal examination procedure?

Answer 4

1 - Inspection
2 - Palpation
3 - Auscultation

Question 5

What are you ‘inspecting’ for in the first stage of an examination?

Answer 5

1. Skin - linea nigra, striae gravidarium
   2 - Shape - might indicate fetal position or presentation
   3 - Scars - note abdominal scares, previous surgery, corresponds to medical history
   4 - Size - consider maternal obesity, previous pregnancies, fetal size and lie, gestation

Question 6

What are the 3 stages of the ‘palpation’ stage of an examination?

Answer 6

• fundal palpation
• pelvic palpation
• lateral palpation

Question 7

Explain the ‘fundal palpation’?

Answer 7

to assess the estimated gestation by assessing fundal height and suggest an indication of lie and presentation

Question 8

Explain the ‘pelvic palpation’?

Answer 8

confirm fetal presentation and engagement (measured in 1/5s).

Question 9

Explain the ‘lateral palpation’?

Answer 9

assess the main body of uterus to identify fetal position and confirm lie, uterine volume, fetal movements and amniotic fluid volume

Question 10

What does it mean to ‘auscultate’ in the 3rd stage of examination?

Answer 10

listen to fetal heart beat with sonicaid and/or pinard

Question 11

During ‘inspection’ what are the Four ‘S’s?

Answer 11

1. Skin - linea nigra, striae gravidarium
   2 - Shape - might indicate fetal position or presentation
   3 - Scars - note abdominal scares, previous surgery, corresponds to medical history
   4 - Size - consider maternal obesity, previous pregnancies, fetal size and lie, gestation

Question 12

State the procedure for abdominal examination (10)

Answer 12

• establish fetal wellbeing
• gain consent
• gather equipment (pinard, sonicaid, gel, tissue, notes)
• mother empty bladder
• semi-recumbent position
• midwife wash hands
• expose abdomen and inspect 4S’s
• fundal palpation, measurement, lateral palpation, pelvic palpation
• auscultate fetal heart
• documentation

Question 13

What factor might influence fundal heigh measurement?

Answer 13

• inaccurate dates (LMP)
• fetal growth
• amniotic fluid volume
• multiple pregnancy
• raised BMI
• abnormal fetal lie
• uterine mass
• poor measuring technique
• intrauterine death

Question 14

What is meant by ‘lie’? What 3 types of lie is there?

Answer 14

The relationship of the long axis of the fetus to the long axis of the uterus

• longitudinal
• transverse
• oblique

Question 15

Define the ‘presentation’? What 5 types of presentation is there?

Answer 15

The part of the fetus that is in the lowest point of the uterus

• cephalic - head first, chin to chest
• breech - bottom first
• face - face up
• brow - forehead, chin extended from chest
• shoulder - emergency section

Question 16

Define ‘position’

Answer 16

The position is the relationship of the denominator to sex point on the pelvic brim

Question 17

Explain the ‘denominator’ in relation to fetal ‘position’

Answer 17

The denominator is the part of the presentation which is used when referring to fetal position - the denominator for a vertex presentation is the occiput

Question 18

List the options for positions in a vertex presentation

Answer 18

Left occipitoanterior (LOA)
Right occipitoanterior (ROA)
Left occipitolateral (LOL)
Right  occipitolateral (ROL)
Left occipitoposterior (LOP)
Right occipitoposterior (ROP)
Direct occipitoanterior (DOA) - middle, back to belly
Direct occipitoposterior (DOP) - middle, back to back

Question 19

Define ‘vertex’

Answer 19

centre of head in cephalic presentation, where the 3 lines meet

Question 20

Define ‘engagement’

Answer 20

the transverse diameter of the fetal skull has passed the brim of the pelvis. Measured in fifths palpable.

Question 21

What is the fetal heart assessed for?

Answer 21

• presence
• rate (110-160bpm)
• regularity
• no decelerations
• acceleration = sign of wellbeing and movement
• check maternal pulse at same time

Question 22

What procedure must you follow post examination?

Answer 22

• communicate findings and offer explanations to woman
• recognise deviations from the norm
• referrals where necessary
• reassurance
• document findings