Abdominal Assessment

ABDOMINAL ASSESSMENT • Abdomen assmt provide information about uterine growth and confirm EDD/EDB • 12 weeks – uterus above symphysis pubis, • 16 week – between symphysis pubis and umbilicus • 20 weeks – at umbilicus • 36 weeks – at xiphoid process • 40 weeks – fetal head x pelvic cavity called lightening.Therefore uterus sinks

Mac Donald Method 1. Women Lies on her back (trunk elevated) with knee flexed 2. Top of fundus palpated and tape stretched from top of symphysis pubis over abdominal curve to the top of fundus. From 22 weeks to term fundal height roughly equals + or – 2 cm to the gestational age of foetus in weeks.

Second & Third trimester • McDonald’s rule : Height of fundus (in Cm) x 8/7 =Duration of pregnancy in weeks Eg: If fundal height = 22cm X 8/7 = 25weeks

Leopold’s Maneuvar Stand beside the women, facing her head with dominant hand near her

First Maneuver

A) Palpate uterine fundus

Distinguish between Ceaphalic and breech (buttocks) presentation – breach is softer and irregular in shape than head. The head is harder, round and uniform shape.

Second Maneuver B) Hold left hand steady on one side of the uterus while palpating the opposite side of the uterus with the right hand. B) Hold the right hand steady while palpating opposite side of uterus with left hand.

To determine which side is the fetal back on and which side the arms and legs (small parts) are on. Fetal back is smooth, convex surface. Fetal arms and legs feel nodular.

Third Maneuver B) Palpate the suprapubic area

To confirm the presentation felt in the first maneuver and to determine if presenting part is engaged.

B) Grasp the presenting part gently between If a breach was palpated in the fundus, expect a hard thumb and finger round head in this area. If the presenting part is not engaged, grasping with the finger moves it upwards in the uterus.

Fourth Maneuver Done only if the fetus is In ceaphalic presentation A)Turn so as to face the womans feet, place hands on each side of the uterus with fingers pointed towards pelvic inlet

To determine whether head is flexed (vertex) or extended (face)

B) Slide hands downward on each side of the uterus, on one side the fingers should slide to upper edge of symphysis, On other side, your fingers meet an obstruction, the cephalic prominence

If head is flexed, ceaphalic prominence (forehead) is felt on opposite side from fetal back, if head is extended, the ceaphalic prominence (occiput) is felt on the same side as the fetal back.

Auscultating fetal heart rate • Purpose – To evaluate fetal condition and tolerance of labour 1.Explain 2.Wash hands (using warm water) 3.Use leopold’s maneuver – Identify back --it is close to maternal abdomen, were fetal heart sound is clear

Equipments to assess FHR • Fetoscope • Doppler transducer (place H2o soluble gel over transducer to make interface for clear signal transmission. Place transducer over fetal back and move it till you hear FHS