Download ppt2d_Antenatal Check Up Abdominal Examination

SBA - Presentation 2 (d)
Antenatal Check Up:
Abdominal Examination
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
Abdominal Examination
What is the importance of abdominal
examination?
• Monitor progress of pregnancy and fetal growth
• Check for fetal lie and presentation
• Auscultate fetal heart sounds
Antenatal Check Up: Abdominal Examination
2
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
Antenatal Check Up: Abdominal Examination
3
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
Antenatal Check Up: Abdominal Examination
4
Significance of fundal height
Indicates
• Duration of pregnancy
• Fetal growth
• Any abnormality in the pregnancy
Antenatal Check Up: Abdominal Examination
5
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
Antenatal Check Up: Abdominal Examination
6
How will you estimate gestational
age from fundal height?
Measurement of fundal height
•
•
•
Divide the abdomen by an
imaginary lines passing
through umbilicus
36 wk
40 wk
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
Xiphisternum
32 wk
28 wk
24 wk
Umbilicus
20 wk
16 wk
Pubic symphysis
(Uterus becomes an
abdominal organ
after 12 weeks)
Antenatal Check Up: Abdominal Examination
7
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
Antenatal Check Up: Abdominal Examination
8
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
Antenatal Check Up: Abdominal Examination
9
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
Antenatal Check Up: Abdominal Examination
10
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
Antenatal Check Up: Abdominal Examination
11
Abdominal palpation:
Four grips
• Fundal grip
• Lateral grip
• Superficial pelvic grip
• Deep pelvic grip
Antenatal Check Up: Abdominal Examination
12
Fundal Palpation / Fundal Grip
Helps to determine lie and presentation of fetus
Antenatal Check Up: Abdominal Examination
13
Lateral Palpation / Lateral Grip
Helps to locate fetal back
Antenatal Check Up: Abdominal Examination
14
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
Antenatal Check Up: Abdominal Examination
15
Second Pelvic Grip / Deep Pelvic Grip
Helps to know the degree of flexion of head
Antenatal Check Up: Abdominal Examination
16
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
Antenatal Check Up: Abdominal Examination
17
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
Antenatal Check Up: Abdominal Examination
18
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)
Antenatal Check Up: Abdominal Examination
19
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
Antenatal Check Up: Abdominal Examination
20
To summarize
Abdominal examination is done for :
• Fundal height
• Fetal lie and presentation
• Fetal movement
• Fetal heart sounds
• Any other abdominal finding
Antenatal Check Up: Abdominal Examination
21
Thank you
Antenatal Check Up: Abdominal Examination
22