Abdominal Examination Flashcards
(19 cards)
How would you welcome Marsha to her appt?
1)Introduce myself - Student Midwife
2) Confirm her name, DOB, Address/ CHI confirm and compare with notes
3) Explain procedure/ what it consists of (abdominal examination)
4) Gain informed consent
5) Make sure there are no contraindications (PV bleeding, soreness)
6) Holistic overview: looking for verbal and nonverbal cues and general wellbeing
What is the purpose of antenatal care?
1) Looking for the wellbeing and assessment of maternal health
2) ensuring fetal health and wellbeing
3) Observe any deviations from the norm for early detection and management of any complications
4)provide antenatal education and referrals of needed
How would you prepare the room for an antenatal examination?
Private room
Maintain Privacy and Dignity
Close any windows and doors
Do not disturb sign on the door if available
How would you prepare yourself and what equipment would you require?
Wash my hands using the WHO 5 moments and 7 Steps of hand hygiene - gel my hands if visibly clean
PPE - Apron and gloves
Equipment - sphynomometre, Doptone & pinnard, Doppler gel, Single use tape measure in CMS, urinalysis sticks, blood pressure cuff, stethoscope, watch, case notes
Describe the component parts of an antenatal booking
1) Vital signs : blood pressure, urinalysis, heart rate, respiratory rate, temperature, blood tests (comparing to booking notes)
2) Oedema (hypertension/preeclampsia)
3) Weight
4) deviating signs from the norm or signs of infection
5) abdominal examination
6) Auscultation of fetal heart
7) Education and counselling
Explain your reasons for performing an abdominal examination at this stage of Marsha’s pregnancy (36 weeks/prim)
Detect deviations from the normal – early detection and manage
any complications
• Assess fetal wellbeing
• Location of the fetal parts
• Assess fetal size and growth ( see if its in line with gestational age)
Preparation and positioning of Marsha is important, explain how you would prepare Marsha and what position, which she should adopt and give your reasons
1) ask if she needs to use the toilet as a full bladder can be uncomfortable during examination
2) lower bed or provide stool for Marsha to position herself on bed
3) Have Marsha in a semi-recumbent position with hands relaxed at her side to relax abdominal muscles
4) provide a towel or small wedge under her right side to give a lift lateral tilt to prevent Inferior Venacaval Occlusion
What will be the effect of inferior Vena caval occlusion?
Weight of the Gravid uterus on the vessel prevents blood returning to the heart and can cause Marsha Supine Hypotension - which causes lightheadedness, dizziness, nausea, sick or loss of consciousness.
What would the midwife do if Marsha becomes dizzy and why?
Stop the examination
Put Marsha on her left hand side to allow blood to return to heart to bring blood pressure back up
Stay with Marsha
Call for help
Give her time to recover
Explain how you would perform an abdominal examination and explain in detail what you would do and why?
A) Inspection
• Ask for consent from Marsha to examine her abdomen, asking her to
lift her top.
• Look at the size and shape of the abdomen - Ovoid in shape?
• Fetal movements
• Full bladder (raised bump)
• Dip around the umbilicus (OP position)
• Rashes, spots or itching, dry skin
• Previous scars from surgery or c sections
• Bruises
• Striae gravidarum (stretch marks)
• Linea nigra
• Fibriods
B) Fundal Height Measurement
Fundal height is a non-evasive way to estimate the gestational age of a
fetus and monitor its growth.
• Measured in CMs
• Position patient in a supine position and ensure bladder is empty
• Use top of your hand from xiphisternum in a C shape until you feel the top
of the fundus. should feel like a firm and rounded.
• Using measure tape face down at 0 - from top of the fundus to the
symphysis pubis.
• Blind side down to avoid bias
• Measure midline and follow curve of the abdomen
• Measure once only
• Document on growth chart – fundal height should correspond to the number
of weeks pregnancy give or take 2-3cm
What Factors may affect the size of the uterus?
-Maternal Fibroids
-Weight/ large BMI
- Polyhydramnios or Oligohydramnios - excess or very little amniotic fluid
-Fetal lie
-Multiple Pregnancies
-Fetus is large or small for their gestational dates
-Placental position (anterior)
C) Fundal palpation
And
Reason for Fundal Palpation
Identify the presenting part of the fetal body part that is in the upper uterine pole, and assess growth
• Use fingertips to feel the upper part of the fundus, work all around the upper pole.
Buttocks will feel bulky/ broad/ soft & moves with body
Head - Breech presentation - rounder/harder/ bollotable
Reason - to determine fetal presentation and assess growth. What is in the lower uterine pole helps determine presentation.
Lateral Palpation
Reason for Lateral Palpation
Hands on each side of abdomen - using One hand to anchor one side at a time. Use other hand and finger tips to walk down the sides gently, but firmly, feel around.
• Lateral palpation gives us more information regarding fetal position and lie
• Looking to identify what side lies the fetal back and what side has fetal
limbs
• Fetal spine should feel hard, constant/ resistant and opposite side should feel irregular/lumpy – limbs, elbows, knees etc
• Keep doing on both sides until you’re happy you can determine the fetal lie and position - long axis of fetus with long axis of uterus, determine if lie is longitudinal
Pelvic Palpation
Reason for Pelvic Palpation
-Turning away from Marsha, use both hands/fingertips (remind her if she’s uncomfortable to tell me to stop)
-She can bend knees slightly for comfort
-Ask her to inhale deep and on exhale push inwards and downwards
Reason - to determine the engagement of the presenting fetal part in the lower uterine pole - confirm presentation as cephalic or breech
NICE Guidelines state it isn’t routinely performed, at least until 36 weeks and above gestation. Can help to plan preferred mode of birth.
36weeks -primigravida
Up until onset of Labour in Parous women
When would you expect the head to become engaged?
36+ for primigravida women
Up until onset of Labour for Parous women
Auscultation
NICE Guidelines state not routinely done, not before 20 weeks, and can be done at mother’s request.
Reason - to confirm life in absence of movement
Fetal HR = 110-160 BPM
Count for one full minute with fobwatch
Place pinnard or Doppler at posterior angle of the anterior fetal aspect/shoulder
Hold pinnard in place with ear (no finger readings)
How would you distinguish between maternal and fetal pulse?
One hand over mother’s radial pulse, noting maternal pulse is slower between 60-100
Following the procedure of abdominal examination what will your actions be?
What findings from the abdominal examination would you document?
Following exam:
Lower bed and allow woman to redress and help get her up
• Discuss any findings with woman
• Allow her to ask any questions/concerns she may have
• Dispose of PPE and single use equipment
• Re-wash my hands
• I would document – gestation, fundal height, fetal lie, presentation,
engagement, FHR, maternal pulse, BP, urinalysis result, weight,
blood tests etc
• Date, time and sign
• Offer follow up appointment
• Refer if necessary
*Say goodbye and offer to walk her out.
