Flashcards in Abdominal Palpation Deck (18)
What are the aims of abdominal palpation?
- Assess foetal size and growth, through SFH from 24/40
- Assess foetal presentation at/after 36/40
- Auscultate the foetal heart
- Detect deviations from normal
How should the midwife prepare for the procedure?
- Ask woman to empty bladder
- Assemble equipment
- Observe and listen to the woman
- Informed consent
- Promote privacy and dignity
- Wash hands
What are the main components of the examination?
Observe abdomen and then assess:
- location of fundus
- foetal growth (SFH)
- foetal lie
- foetal presentation
- engagement of presenting part
and document all findings
What should be observed on the woman's abdomen?
- Size of bump
- Shape of bump
- Notable skin changes
- Foetal movements
- Evidence of previous scars or signs of domestic violence
Why should the woman not lie flat?
Puts pressure on major blood vessels
Name some of the skin changes that may be observed
- Linea nigra
- Striae gravidarum (stretch marks)
- Infections (e.g. chicken pox)
- Polyhydramnios (enlarged abdomen - excess fluid)
What does a dip at the umbilicus indicate?
If the woman is complaining of back pain, what may this indicate?
Occipitoposterior baby (back to back)
What is the technique for assessing the uterine fundus?
Using the hand nearest the woman, the pads of the fingers are placed on the abdomen below the xiphisternum and moved gently downwards until the firmness of the curved upper border of the fundus is felt
How should the SFH be measured?
- 24/40 onwards
- Use tape measure and secure at fundus with 1 hand
- Measure from top of fundus to top of SP
- Measure once only
- Discuss and document findings
Define the term 'lie'
The axis of the baby in relation to the maternal spine/ relationship between long axis of foetus and long axis of uterus
Define the term 'presentation'
Which part is showing at the pelvis
- Cephalic/ Vertex (head)
- Sacrum/ Breech (bottom)
Define the term 'position'
How the presentation is lying
- Right OP etc
- Right/ left refers to woman's right/left, not our perspective
How should foetal presentation be assessed?
1. Fundal palpation
2. Lateral palpation
3. Pelvic palpation
Why is SFH measured?
- SFH possible indicator of foetal growth
- Poor foetal growth is a cause of serious perinatal mortality and morbidity
Why is foetal presentation assessed?
- Assists with foetal HR auscultation
- May determine mode of birth
What is engagement of the presenting part?
- Occurs when widest presenting transverse diameter of presenting part has passed through pelvic brim
- In primips, this occurs at any time from 36/40
- In multipara, the head may not engage until as late and the onset of labour
- Engagement measures in 5ths palpable above pelvic brim