ANTENATAL ABDOMINAL EXAMINATION

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 top the maternal pelvis

PURPOSES

 To measure the abdominal girth and fundal height

 To determine the abdominal muscle tone
 To determine the fetal lie, presentation, position, variety and engagement
 To determine the possible location of the fetal heart tones.
 To observe the signs of pregnancy
 To detect any deviation from normal

ARTICLES

 Fetoscope/sthethoscope/Doppler machine.
 Measuring tape/pelvimeter

PROCEDURE

Nursing action Rationale

Explain to the woman what will be done and Reduces anxiety and promotes relaxation
she may cooperate during procedure
Instruct the woman to empty her bladder Avoids discomfort during palpation
Draw curtains around the bed Provides privacy
INSPECTION
Position the woman for examination
 Place a pillow under her head and Promotes relaxation of abdominal muscles
upper shoulders
 Have her arms by her sides Enable visualization of whole abdomen
 Expose her abdomen from below the
breasts to the symphysis pubis
Inspect abdomen for following:
Scars ,Diastasis recti, hernia, linea nigra,
striae gravidarum, contour of the abdomen,
state of umbilicus, skin condition
Determine the fundal height using the ulnar Provides an estimate whether the fetal
side of the palm growth corresponds to gestational period.
12 weeks -level of symphysis pubis
16 weeks -midway between symphysis pubis
and umbilicus
24 weeks-level of umbilicus
36 weeks-at level of xiphoid process
40 weeks-2-3 fingers breadths below xiphoid
process

Measure fundal height using any one of the

following method.
a) Using measuring tape-
 Place zero line of the tape measure on The number of centimeters measured should
the superior border of the symphysis be approximately equal to weeks of gestation
pubis after about 22 to 24 weeks
 Stretch the tape across the contour of
the abdomen to the top of fundus
along midline This method is more accurate
 b) Caliper method(pelvimeter)
 Place one tip of the caliper on the
superior border of the symphysis
pubis and the other tip at the top of
the fundus. Both placements are in the
midline.
 Read the measurement on the
centimeter scale located on the arc,
close to the joint. The number of
centimeters should be equal
approximately to the weeks of
gestation after about 22-24 weeks.

Measure the abdominal girth by encircling Normally the measurement is 2 inches less
the woman’s abdomen with a tape measure at than the weeks of gestation
the level of the umbilicus.

ABDOMINAL PALPATION OR LEOPOLD’S MANEUVERS

Instruct the woman to relax her abdominal These steps reduce the stretching and tension
muscles by bending her knees slightly and of abdominal muscles
doing relaxation breathing
Be sure your hands are warm before Cold hands may cause muscle contraction
beginning to palpate, rest your hand on the and discomfort. Resting hands on mother’s
mother’s abdomen lightly while giving abdomen would help her to become
explanation about the procedure. accustomed to your touch and dissipate
muscle tightening
For the technique of palpation, These measures would aid in gathering
 Use the flat palmar surface of fingers greatest amount of information with least
and not fingertips. Keep fingers of discomfort to the woman
hands together and apply smooth deep
pressure as firm as is necessary to
obtain accurate findings
Perform the first maneuver( Fundal
palapation) Round, hard, readily movable part, ballotable
 Face the woman’s head between the fingers of both hands is
 Place your hands on the sides of indicative of head.
fundus and curve the fingers around Irregular, bulkier, less firm and not well
 the top of the uterus defined is indicative of breech
 Palpate for size, shape, consistency,
and mobility of the fetal part in the
fundus

Do the second maneuver(lateral palpation)

 Continue to face the woman’s head
 Place your hands on both sides of the
uterus about midway between the
symphysis pubis and the fundus
 Apply pressure with one hand against A firm convex, continuously smooth and
the side of uterus pushing the fetus to resistant mass extending from breech to neck
the other side and stabilizing it there is indicative of fetal back. Small knobby,
 Palpate the other side of the abdomen irregular mass, which move when pressed is
with the examining finger from the indicative of the fetal small parts
midline to the lateral side and from
the fundus using smooth pressure and
rotatory movements.
 Repeat the procedure for examination
of the opposite side of the abdomen

Third maneuver (Palwik’s grip)

 Continue to face the woman’s head, Avoids discomfort
make sure the woman has her knees
bent If the fetal head is above the brim, it will be
 Grasp the portion of lower abdomen readily movable and ballotable. If not readily
immediately above the symphysis movable, it is indicative of an engaged head
pubis between the thumb and middle
finger of one of your hands
Fourth maneuver (pelvic palapation)
 Turn and face the woman’s feet Avoids pain with maneuver
 Place your hands on the sides of
uterus, with the palm of your hands
just below the level of umbilicus and
your fingers directed towards the
symphysis pubis This maneuver determine level of
 Press deeply with your fingertips into engagaement
the lower abdomen and move them
toward the pelvic inlet
 The hands coverage around the
presenting part when head is not
engagaed
 The hands will diverge away from the
presenting part and there will be no
mobility if the presenting part is
engaged
AUSCULTATION
Place fetoscope or sthethoscope over the Fetal heart sounds are heard over fetal back
convex portion of the fetus, closest to the in vertex and breech presentation. Over chest
anterior uterine wall in face presentation

AFTER CARE

 Inform the mother of your findings

 Replace articles and wash hands
 Record in the patient’s chart the time, findings and remarks if any

Reference
 Annamma Jacob’s, clinical nursing procedures: the art of nursing practices,3rd
edition ,Published by Jaypee brothers medical publishers Page no.527-528