Pregnant abdomen examination Flashcards
What is the ideal position for a patient during a pregnant abdomen examination?
Lying at 15 degrees with abdomen exposed
What is involved in the general inspection of a woman during pregnant abdomen examination?
General:
- well/unwell
- comfortable
- breathless
- pallor
Pulse rate
Head and neck:
- chloasma/jaundices sclera (obstetric cholestasis)
- conjunctival pallor (anaemia)
- nasal congestion
- facial oedema
Legs and feet:
- Swelling
- Oedema
- Varicose veins
What is involved in the abdominal inspection during pregnant abdomen examination?
- Distension
- Foetal movements
- Scars - previous C-section scars, laparoscopic scars (ectopic?)
- Skin changes
- Cough for hernias
What skin changes commonly occur during pregnancy that may be seen during examination of a pregnant abdomen?
- Linea nigra (dark line from xiphisternum or umbilicus to suprapubic region)
- Striae gravidarum: purplish striae (no clinical significance)
- Striae albicans (old silvery-white striae - indicates parity)
- Excoriations (obstetric cholestasis)
- Distended superficial veins (increased IVC pressure due to gravid uterus)
- Umbilical inversion (occurs due to increased abdominal pressure)
What should you do before palpating a pregnant abdomen?
- Warm hands (assuming you’ve washed hands at beginning of station; can always wash hands again)
- Ask about pain
What are the different steps in palpating a pregnant abdomen?
- Fundal height
- Lie
- Presentation
- Liquor volume
How do you assess fundal height on a pregnant abdomen?
- Use ulnar edge of your left hand to press down in a stepwise fashion from xiphisternum downwards to find the fundus
- Measure from this point to the pubic symphysis with a measuring tape
- Measure with the cm side down to eliminate bias
- Turn tape over for reading in cm
If a pregnant abdomen is larger than expected, what might this indicate?
- Macrosomia
- Polyhydramnios
- Multiple pregnancy
- Wrong dates
- Fibroids
If a pregnant abdomen is smaller than expected, what might this indicate?
- UGR
- Oligohydramnios
- Small baby
How do you assess lie in a pregnant abdomen?
- Face the mother’s head and place your hands on each side on the top pole of the uterus, applying gentle pressure
- Walk hands down the sides of the abdomen using palms and all 4 fingers
- if one side feels firm = baby’s back
- Can support each side in turn and push the foetus up against it with the other hand
- Baby vertical = Longitudinal lie
- Baby diagonal = Oblique lie
- Baby horizontal = Transverse lie
How do you assess foetal presentation in a pregnant abdomen?
*important in women >37 weeks
- Face the mother’s feet
- Feel for presenting part by pressing on either side of the lower pole of the uterus
- If you unable to feel baby’s head, progress more medially until you are able to
- Cephalic presentation = round presenting part (head)
- Breech presentation = broader soft presenting part, e.g. bottom
- Ballot the head by pushing it gently from one side to another, being very gentle (can be uncomfortable for the mother)
- Engagement: how many fifth of the head are palpable (basically how many fingers can you feel the fingers with)
How do you assess liquor volume in a pregnant abdomen?
- Palpate around and ballot fluid to assess the approximate quantity, i.e. oligohydramnios, polyhydramnios
What is a normal fundal height at 12 weeks?
Uterus should be palpable, can’t really measure at this stage
What is a normal fundal height at 20-22 weeks?
Fundus near the umbilicus (±2cm)
What is a normal fundal height at 36 weeks?
Fundus should be near xiphisternum (±3cm)
