Saturday , June 23 2018
Abdominal Examination Palpation

ABDOMINAL EXAMINATION

Purpose

  • To confirm pregnancy.
  • To assess fetal size and growth.
  • To identify the location of fetal parts.
  • To detect any deviation from normal.

Scope

Pregnant mothers.

Definition

Examination of a pregnant woman to determine the normalcy of fetal growth in relation to the gestational age, position of the fetus in uterus and its relationship to the maternal pelvis.

Applicable Areas

 Gyneac & Obstetric Department and Gyneac & Obstetric OPD.

Responsibility

Consultant, Medical Officer, Staff Nurse, Auxillary Nurse Midwife and Head Nurse.

Equipment

The examiner will need pinard’s stethoscope or sonic aid for auscultation of F.H.S.

Procedure

  • Performed in three distinct parts –
  • Inspection
  • Palpation
  • Auscultation
  • Explain procedure to the woman.
  • Ensure woman’s bladder is empty.
  • Provide privacy.
  • Position her semi-sitting on Gyneac table as her comfort permits and knees slightly flexed.
  • Inspection
  • Stand on right side of the woman, if you are right handed.
  • Observe the abdomen for size in relation to period of amenorrhea.
  • Note the shape and contour[Outline] of the abdomen, the shape usually indicates the fetal lie.
  • Scars and striate gravid arum confirm reason for significant scars.
  • Fundal Level – Place the ulnar border of the left hand just below the xiphi sternum, press gently down the abdomen till curve of fundus is felt, measure the number of fingers can fit between the fundus and xiphi sternum.
  • Palpation

Palpation is done in 3 special movements with warm relaxed hands and arms using, the pads of the fingers movements over the abdomen should be smooth.

  • Second maneuver.
  • Lateral Palpation –
  • Place one hand on each side of the abdomen.
  • Use one hand to steady the uterus and the other to palpate. Alternate hands and walk the finger tips of both hands over the abdomen to feel the back.
  • Third maneuver
  • Pelvis grips –
  • First Pelvis grips : “Pawlik grip”

Grasp the lower part of the uterus between index and thumb, spread vide enough to fit the head, don’t put much pressure.

  • Second pelvis grip –
  • Turn to face the woman’s feet.
  • Ask the woman to bend her knees slightly and breathe steadily with her mouth open.
  • Hold the sides of the uterus just below the umbilicus with fingers close together, pointing downwards and in wards.
  • Auscultation :
  • Place the pinard fetal stethoscope at right angles about 5 cm above the head on the side of abdomen where the back was felt, keep the ear in firm contact with the pinard, don’t touch it while listening.
  • Fetal heart rate ranges between 120-160 b/m.
  • Listen carefully and count for 30 – 60 second.

Documentation

  • Patient’s IPD File
  • OPD Paper