Antenatal Check Up: Abdominal Examination

SBA - Presentation 2 (d)

Maternal Health DivisionMinistry of Health & Family Welfare

Government of India

Antenatal Check Up: Abdominal Examination 2

Abdominal Examination

What is the importance of abdominalexamination?• Monitor progress of pregnancy and fetal

growth• Check for fetal lie and presentation• Auscultate fetal heart sounds

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Abdominal Examination

What does it include? • Measurement of fundal height

• Assessment of fetal lie and presentation

• Assessment of fetal movement

• Auscultation of fetal heart sounds

• Inspection for scars

• Other relevant abdominal findings

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Preparation for abdominal examination

• Ensure privacy

• Examination room should be well lit and airy

• Woman is asked to empty her bladder

• Explain the women about the procedure/process

• To make her comfortable, keep talking to her

• She lies supine with legs partially flexed

• Stand on her right side

• Palpate the uterus with warm hands

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Significance of fundal height

Indicates • Duration of pregnancy

• Fetal growth

• Any abnormality in the pregnancy

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Assessment of fundal height

• Keep the ulnar border of curved left hand on woman’s abdomen parallel to symphysis pubis

• Start from xiphisternum and gradually proceed towards symphysis pubis lifting the hand between each step till a bulge / resistance of uterine fundus is felt

• Mark the level of fundus

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How will you estimate gestational age from fundal height?

Xiphisternum

Umbilicus

Pubic symphysis(Uterus becomes an abdominal organ after 12 weeks)

Measurement of fundal height

• Divide the abdomen by an imaginary lines passing through umbilicus

• Divide the lower abdomen in 3 parts with 2 equidistant lines between the pubic symphysis and the umbilicus

• Divide the upper abdomen into 3 parts again with 2 imaginary equidistant lines between the umbilicus and xiphisternum

24 wk

20 wk

16 wk

28 wk

32 wk

40 wk

36 wk

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Measuring Fundal Height

• Measure the distance from the upper border of symphysis pubis along the uterine curvature to the top of the fundus with a tape.

• Gestational age in weeks corresponds to the fundal height in cms from 24 weeks to 30 weeks

• Refer to MO (with referral slip) if

Disparity between the fundal height and gestational age is > 3 cm

or

No increase in fundal height on subsequent visit

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What are the reasons of fundal height more

than the period of gestation?

• Wrong date of LMP

• Full bladder

• Multiple pregnancy

• Large baby

• Polyhydramnios

• Hydrocephalous

• Hydatidiform mole

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What are the reasons of fundal height less than the period of gestation?

• Wrong date of LMP

• Intra-uterine growth restriction (IUGR)

• Missed abortion

• Intrauterine death ( IUD)

• Transverse lie

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Fetal lie and presentation

• Examine after 32 wks pregnancy (after this period the lie usually remains the same till delivery)

• Palpate for fetal lie and presentation

• Normal lie is longitudinal with cephalic presentation

• Abnormal lie and presentation should be referred to FRU with referral slip

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Abdominal palpation:

Four grips

• Fundal grip

• Lateral grip

• Superficial pelvic grip

• Deep pelvic grip

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Fundal Palpation / Fundal Grip

Helps to determine lie and presentation of fetus

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Lateral Palpation / Lateral Grip

Helps to locate fetal back

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First Pelvic Grip / Superficial Pelvic Grip

• Helps to determine whether head or breech is presenting at pelvic brim

• Whether the presenting part is engaged / fixed / free

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Second Pelvic Grip / Deep Pelvic Grip

Helps to know the degree of flexion of head

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Foetal movements

• Fetal movement are reliable sign of foetal well - being

• These are felt around 18-22 wks of pregnancy (felt earlier in multigravida than primigravida)

• Normally 10-12 foetal movements should be felt by the pregnant woman in a day

• Decreased foetal movements may be an indication of foetal distress

• Pattern of foetal movement may change prior to labour due to reduced space

• If Foetal Movements are absent or not felt, consult ANM or doctor

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Fetal heart sound (FHS) and rate (FHR)

• FHS is heard per abdomen by stethoscope / fetoscope after 24 weeks of pregnancy

• Normal FHR is 120 – 160 beats per min• FHR < 120 beats per min or > 160 beats

per min

: Indicates fetal distress and calls for referral

• Confirm that you are listening to the FHS and not maternal pulse

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Auscultation of FHS

• Use a fetoscope or stethoscope

• Best heard on the side of the back of the fetus

• In vertex presentation FHS is best heard midway between the line joining the umbilicus and the anterior superior iliac spine on the side of the back

• In breech presentation FHS is heard above the umbilicus

• Count the FHS for one full minute (FHR)

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Suspicion of multiple pregnancy on abdominal examination

• An unexpectedly large uterus for the estimated gestational age

• Multiple fetal parts felt on abdominal palpation

• FHS is heard at more than one place

Refer the woman to FRU with referral slip and arrange for institutional delivery

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To summarize

Abdominal examination is done for :

• Fundal height

• Fetal lie and presentation

• Fetal movement

• Fetal heart sounds

• Any other abdominal finding

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Thank you