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Obstetric abdominal examination (Palpation (Foetal lie Longitudinal…
Obstetric
abdominal
examination
Preparation
Exposure
Xiphisternum to pubic symphysis
Position
Semi recumbent (flat can obstruct
IVC causing symptomatic hypotension)
Introduce
Introduce self, explain exam,
gain consent
Pain
Pain in abdomen
Gestation
Wash
Wash/gel hands
Inspection
Scars
Laparotomy (previous ectopic, ovarian mass)
Laparoscopic (various gynae/abdo/pelvic procedures)
Pfannensteil (transverse suprapubic) (caesarean section)
Abdo distension
Apparent size
6 Fs: fat, flatus, fluid, faeces, foetus, frecking big mass
Cutaneous signs
Linea nigra (dark line from xiphisternum to pubis)
Striae gravidarum (new purple stretch marks)
Striae albicans (old white stretch marks)
Flat/everted umbilicus (increased intra-abdo pressure)
Dilated superficial veins (collateral flow due to IVC pressure)
Foetal movement
Note any visible movement
Legs
Peripheral oedema (physiological, pre-eclampsia)
Palpation
Foetal lie
Longitudinal axis of foetus v longitudianal axis of uterus
Explain that you are now going to feel for baby
One hand either side of uterus
Longitudinal - head/breach over pelvic inlet
Transverse - head/breach in flanks
Oblique - head/breach in RIF/LIF
Presentation
Part of the foetus occupying the lower pole of the uterus
Explain that you are now going to feel deeply
Palpate over lower uterus
Cephalic, breech, other (shoulder, compound)
Symphysis-fundal height (SFH)
Only if >20w; SFH in cm should be gestation +/-3wk
Uterus palpable from 12wk
At umbilicus 20w, xiphisternum at 36w
Explain that you are going to feel the top of the womb
Start at xiphisternum, work down to fundus, put end of tape at 0
Measure to pubic sympysis with measurements facing downwards; complete 3 measuremets
Station (engagement)
If cephalic, determine how many finger breadths are needed
to cover foetal head over the pelvic brim
3 or less = engaged
Liquour volume
Clinical estimation
Tense abdo, foetus not easily felt - high (check for fluid thrill)
Compact abdo, foetus easily felt - low
Vertex
Determined by internal examination
Area on foetal head determined by anterior and posterior fontanelles and parietal eminances (4 bones ant, 3 bones post)
Position
Relation of the denominator of presenting part to the
quadrants of the maternal pelvis
If cephalic, occiput, if breech, use sacrum
Auscultation
Position
Locate anterior shoulder
Doppler USS
Can be used from >12w
Jelly on probe, adjust until heartbeat heard
Listen 1m (normal 120-140 bpm)
Compare with maternal pulse
Pinard stethosope
Best from 24w
Listen 1m (normal 120-140 bpm)
Compare with maternal pulse
