Flashcards in Abdominal Palpation Deck (21)
What is an abdominal examination?
Abdominal examination is a skill that is used to assess fetal growth during pregnancy to determine the presentation, position and the lie of a fetus as pregnancy progresses.
When is an abdominal examination carried out?
According to NICE 2008 an abdominal examination is carried out from 24 weeks gestation and is assessed by measuring the symphysis-fundal height.
When should an abdominal examination be carried out?
-At each antenatal visit from 24 weeks of pregnancy.
-Prior to auscultation of the fetal heart and use of CTG equipment.
-Before a vaginal examination
What should midwives be cautious of when carrying out an abdominal examination?
The uterus can be stimulated whilst this skill is carried out, therefore it is important to take extra caution when a woman has experienced placenta abruption and preterm labour.
What to do before the procedure is carried out?
-Ensure the woman is comfortable and is experiencing no discomfort,
-Explain the procedure to the woman and point out at any point she wishes for the midwife to stop, we will.
-Gain informed consent whilst remaining the respect and dignity of the woman.
-Ensure hands are washed and dried thoroughly and the correct PPE is worn.
-Ensure the woman has emptied her bladder as this can cause discomfort.
-Ensure the woman’s hands are both lay by her side.
-That she is lay in a semi-recumbent position as this allows less weight to be pressed against the vena cava.
-Discuss findings and document accordingly.
Prior to examination, what must be observed?
The visual appearance of the abdomen, a lot of information can be gained for this.
-Look at the size of the abdomen I.e indications of obesity, multiple pregnancy, poly-olighydramnios, fetal size, gestation period.
-The shape of the abdomen may indicate fetal position, presentation and lie. For example a dip at the umbilicus can indicate an occipitoposterior position.
-Observe for any skin damages, stretch marks, previous surgery such as c-section, rashes or itching.
-Fetal movements may be observed.
-Signs of domestic abuse, I.e bruising
How to measure fundal-height and why we do it?
Fundal-height provides approximation of gestation. It is carried out from 24 weeks using a disposable tape measure and the result is plotted onto a growth chart.
Procedure: obtaining symphysis-fundal height measurement.
-Discuss procedure with woman and gain consent.
-Encourage to empty bladder.
-Gather equipment: disposable tape measure, antenatal records, sheet (if needed).
-Semi-recumbent position and knees slightly bent.
-Ensure privacy and dignity is respected.
-Wash and dry hands thoroughly, ensure correct PPE is worn.
-Locate top of fundus and place non-stretchable tape measure face down so that 0cm is at the top of the fundus.
-Pull the tape measure down to the symphysis-pubis.
-Discuss and document findings.
-Refer when needed i.e baby showing large/small/absent growth.
Fundal palpation procedure.
Determines which pole is in the upper part of the uterus.
-Midwife faces the woman so any discomfort can be seen.
-Midwife placed her hands on top of the fundus below the xiphisternum.
-Once felt, the Palmer sides of fingers of both hands are placed either side of the fundus and gently applying pressure palpating.
-Buttocks often appear to feel broad, softer and ballotable.
-If no pole is felt this may indicate a transverse lie.
What are the three types of lie?
Longitudinal-straight in-line with the mother’s body and is the most common
Oblique- on an angle (slightly sideways)
How long should we auscultation for?
What is engagement and how is it measured?
The relationship between the presenting part and the brim of the maternal pelvis, measured in 5ths and by palpating above the symphysis pubis, for example, the head is 3/5 engaged, only 2/5 is palpable
What is the denominator and what are the landmarks for a cephalic breech and face presentation?
The landmark determining what position the baby is in.
Cephalic: Occiput (back of fetal head)
Face: Mentum (chin)
What are the risks of abdominal palpation?
If a woman is lay semi-recumbent for too long it may compress on the vena cava which supplies the uterus with blood.
It may also be uncomfortable for the woman. Particularly when palpating to determine engagement
What is auscultation and what are we looking for?
Auscultation is the act of listening to the fetal heart rate (FHR) through a sonicaid and/or a pinard.
We are looking for: Presence (rate of 110-160bpm)
What is the attitude and what are the three types?
The relationship of the fetal head to its body. They can affect the presenting fetal skull diameter during intrapartum.
-Fully flexed (Chin tucked into shoulders, curved back)
-Poorly flexed (Not tucked in, straight back)
-Extended (Head tilted back)
When a woman is 24 weeks gestation where ours we expect the top of the fundus to be?
In line with the umbilicus
When a woman is around 16 weeks gestation where would we expect the top of the fundus to be located?
Between the umbilicus and symphysis pubis
If a fundal height is higher than expected, what may this indicate?
-That the fetus is larger than expected
-That the amniotic fluid might be greater than expected (Polyhydramnios)
-Uterine mass e.g fibroids, cyst or tumour
What may a shorter fundal height indicate?
-That the fetus is smaller than expected (oligohydramnios)
-Abnormal lie (transverse)
-Intrauterine death (IUD)