National College of Nursing: Procedure ON

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NATIONAL COLLEGE OF NURSING

SUBJECT: OBSTETRICS AND GYNAECOLOGY NURSING

PROCEDURE
ON
ANTENATAL ABDOMINAL EXAMINATION AND PALPATION

SUBMITTED TO:
MS. AHUTI MEHTA

PROFESSOR

NATIONAL COLLEGE OF NURSING

SUBMITTED BY:
SUMIT KUMARI

M.Sc. NURSING 1ST YEAR

ROLL NO.-

SUBMITTED ON:
PERFORMING AN ANTENATAL ABDOMINAL EXAMINATION AND
PALPATION
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.

PURPOSES

 To measure the abdominal girth and fundal height.

 To determine the abdominal muscle tone.

 To determine the fetal lie, presentation, position, variety (anterior or posterior) 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

1. Fetoscope/stethoscope/Doppler machine.

2. Measuring tape/Pelvimeter.

PROCEDURE

1. Explain to the woman what will be done and how she may cooperate.

2. Instruct the woman to empty her bladder.

3. Draw curtains around the bed.

INSPECTION

Position the woman for examination.

4 .a. Place a pillow under her head and upper shoulders.

b. Have her arms by her side

c.Expose her abdomen from below the breasts to the symphysis pubis.

5. Inspect abdomen for the following: Scars, diastasis recti, hernia, linea nigra, striae
gravidarum, contour of the abdomen, state of umbilicus, skin condition.
6. Determine the fundal height using the ulnar side of the palm.

a. 12 weeks- level of symphysis pubis

b. 16 weeks- midway between symphysis pubis and umbilicus

c. 20 weeks-1-2 finger breadths below umbilicus

d. 24 weeks-Level of umbilicuse.

e. 28 weeks-3 finger breadths above the umbilicus (1/3rd of the way between umbilicus and
xiphoid process)

f. 32 weeks-halfway between umbilicus and xiphoid process

g. 36 weeks-at level of xiphoid process

h. 40 weeks-2-3 finger breadths below the xiphoid process if lightening occurs

7. Measure fundal height using any one of the following methods:

a. Using measuring tape .

 Place zero line of the tape measure on the superior border of the symphysis pubis.

 Stretch the tape across the contour of the abdomen to the top of the fundus along the
midline.

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.

8. Measure the abdominal girth by encircling the woman's abdomen with a tape measure at the
level of the umbilicus

ABDOMINAL PALPATION OR LEOPOLD'S MANEUVERS

9. Instruct the woman to relax her abdominal muscles by bending her knees slightly and doing
relaxation breathing.

10.Be sure your hands are warm before beginning to palpate, rest your hand on the mother's
abdomen lightly while giving explanation about the procedure.

11. For the technique of palpation,

a. Use the flat palmar surface of fingers and not fingertips. Keep fingers of hands together and
apply smooth deep pressure as firm as is necessary to obtain accurate findings.

12.Perform the first maneuver (Fundal palpation)

a. Face the woman's head.

b. Place your hands on the sides of the fundus and curve the fingers around the top of the uterus.

c. Palpate for size, shape, consistency and mobility of the fetal part in the fundus.
13. Do the second maneuver (lateral palpation)

a. Continue to face the woman's head.

b. Place your hands on both sides of the uterus about midway13between the symphysis pubis and
the fundus.

c. Apply pressure with one hand against the side of the uterus pushing the fetus to the other side
and stabilizing it there.

d. Palpate the other side of the abdomen with the examining fingers from the midline to the
lateral side and from the fundus using smooth pressure and rotatory movements.

e. Repeat the procedure for examination of opposite side of the abdomen.

14. Third maneuver (Pawlik's grip)

a. Continue to face the woman's head, make sure the woman has her knees bent).

b. Grasp the portion of the lower abdomen immediately above the symphysis pubis between the
thumb and middle finger of one of your hands.

15. Fourth maneuver (pelvic palpation)

a. Turn and face the woman's feet (make sure the woman's knees are bent).

b. Place your hands on the sides of the uterus, with the palm of your hands just below the level of
umbilicus and your fingers directed toward the symphysis pubis.

c. Press deeply with your fingertips into the lower abdomen and move them toward the pelvic
inlet.

d. The hands converge around the presenting part when head is not engaged

e. The hands will diverge away from the presenting part and there will be no give or mobility if
the presenting part is engaged or dipping.

AUSCULTATION

16. Place fetoscope or stethoscope over the convex portion of the fetus, closest to the anterior
uterine wall of the fetus

17. Inform the mother of your findings. Make her comfortable.

18. Replace articles and wash hands.

19. Record in the patient's chart the time, findings and remarks, if any.
Note

1. Pelvic palpation may be performed as the third maneuver before performing Pawlik's grip, to
feel the cephalic prominence and to confirm the presentation.

2. Pawlik's grip as the 3rd maneuver is recommended in this book as this sequence has
advantages of performing three maneuvers which require the nurse to be facing the client's head
first and then turning to her feet for pelvic palpation (4th maneuver) without taking her hands off
the mother's abdomen.

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