Obstetric Abdominal Examination

Question 1

What are the steps?

Answer 1

Clean your hands

Introduction and Identification

Explanation

Exposure

Position

Inspection

Palpation

Measure fundal height (after 20 weeks)

Feel for presenting part

Feel for engagement (after 36 weeks)

Auscultation

Complete the examination

Question 2

Introduction and Explanation

Answer 2

Give your name and status

Explain to patient what you wish to examine. Await the patient’s verbal consent

Ask if patient needs to empty their bladder

Question 3

Exposure

Answer 3

Request exposure from below breasts to pubic bone

Question 4

Position

Answer 4

Ask patient to lie on a low pillow if comfortable

In late pregnancy offer more pillows and left lateral position - patient must not lie flat because of caval compression

Question 5

Inspection

Answer 5

• Scars
• Striae gravidarum
• Linea nigra
• Note for uterus swellings from end of bed

Question 6

Palpation

Answer 6

Ask patient if they have any tenderness, face patient

Flex fingers to gently palpate upper and lateral edges of mass

Feel for the 2 foetal poles (the head and breech) to find lie and using the side of the hand find the highest point of uterus (fundus) - this may not be in the midline

Question 7

Measure Fundal Height (after 20 weeks)

Answer 7

Fix disposable tape measure down at highest point, measure to top of symphysis pubis

Take one single measurement, the fundal height should be equivalent to the gestation in weeks +/- 3 cms

Question 8

Feel for presenting part

Answer 8

Place both hands at base of the uterus, above pubic bone, warning patient of possible discomfort

Ballot the head gently or note if note possible

Question 9

Feel for engagement (after 36 weeks)

Answer 9

Estimate how much of the head is still palpable on abdominal examination (imagine dividing the head into fifths)

Question 10

Auscultation

Answer 10

Listen for foetal heart over baby’s anterior shoulder using a doptone/doppler

Question 11

Complete the examination

Answer 11

Inform the patient that you have completed the examination and ask her to get dressed

Thank the patient

Question 12

Findings of Obstetric Abdominal Examination summarised

Answer 12

Inspection - Striae gravidarum, Scars, Linea nigra, Foteal movements, Abnormal size/shape

Growth - symphysiofundal height

Lie - Longitudinal/transverse/oblique

Presentation - Cephalic/breech

Auscultation - Foetal heart over anterior shoulder (110-160bpm)

Question 13

What is a normal foetal heart rate?

Answer 13

110-160 bpm