Abdominal Palpation Flashcards Preview

MIDW127 - Beginning the Journey > Abdominal Palpation > Flashcards

Flashcards in Abdominal Palpation Deck (16):
1

Aim of Abdominal Palpation

- To assess foetal growth, size, position, presentation, lie, attitude and well-being
- Auscultate foetal heart
- To detect deviations from normal

2

Leopold's Manouvres

Systematic approach to abdominal palpation to determine foetal lie, presentation and attitude

3

Indications

- Each antenatal assessment, particularly after 24 weeks
- On admission to hospital
- Prior to auscultation of foetal heart and use of CTG equipment
- Prior to VE
- Throughout Labour

4

Contraindications

As it can stimulate the uterus, caution required when:
- Placenta abruption
- Preterm labour

5

Principles

- Overall Assessment of Mother first - look & listen
- Informed consent
- Maintain privacy and dignity
- Mother's comfort
- Documentation
- Discussion

6

Technique

- Inspection (Size, shape, skin changes, foetal movements may be seen)
- Palpation (fundal, lateral and pelvic)
- Ausculatation

7

Inspection

- Size (affected by obesity, lax abdominal muscles, multiple pregnancy, poly and oligohydramnios, foetal size and lie, gestation)
- Shape (may give an indication of foetal position/presentation)
- Skin changes (linea nigra, striae gravidarum, signs of previous abdominal surgery)
- Foetal movements may be seen

8

Fundal Palpation

- Assess estimated gestation
- Indicator of lie and identification of pole suspected presentation of the foetus confirmed

9

Fundal Height Inconsistent with Gestation may Indicate

- Unreliable landmarks
- Inaccurate dates
- Foetus larger or smaller than expected
- More or less amniotic fluid than expected
- Multiple Pregnancy
- Abnormal Lie
- Uterine Mass
- Poor technique
- Intrauterine Death

10

Identifying the Pole

- Buttocks: Softer, Bulkier, Less Ballotable
- Head: Rounder, Firmer, Ballotable
- Pole located in fundus means a longitudinal line

11

Lateral Palpation

- Identifies foetal position and confirms lie (usually longitudinal, can be oblique or transverse)
- The spine is usually firmer and smoother
- Limbs are less regularly defined
- The lie of the foetus is determined by the relationship of the long axis of the foetal spine to the long axis of the material uterus

12

Pelvic Palpation

- Assesses presentation
- Flexion
- Engagement
- Five main presentations:
~ Vertex
~ Brow
~ Face
~ Breech
~ Shoulder

13

Engagement

Engagement is defines as the point when the engaging diameter goes past the pelvic brim

14

Fundal Height

- Reflects the progression of foetal growth
- To measure fundal height, use a tape measure to gauge length from the notch of the symphisis pubis to the top of the funds, centimetres equals approximate weeks gestation after 20 weeks.

15

Foetal Heart Rate

- Ranges from 110-160 beats per minutes when auscultating for one minute
- Can detect as early as ten weeks gestation with doppler. Listen midline of the woman's abdomen above the pubic hairline.
- After 20 weeks gestation palpate for foetal back using Leopold's manoeuvres. Listen over foetal thorax or back (scapula)
- Foetal Heart Rate should be auscultated and counted for one minute while simultaneously counting maternal pulse

16

Foetal Heart Rate Auscultation

- Pinard can be used from 24 weeks gestation, is a learned and practised skill
- Dopple can be used earlier than pinard, and the mother can also hear the FHR