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 to the maternal pelvis.

Purpose:-

1. To measure the abdominal girth and fundal height

2. To determine the abdominal muscle tone
3. To determine the fetal lie, presentation,position, and engagement
4. To observe the sign of pregnancy
5. To detect the any deviation from normal.

Articles:-

1. Fetoscope
2. Stethoscope
3. Measuring tape
4. Pelvimeter

procedure

Nursing action Rational

1.Explain to the women what will be Reduce anxiety and promotes
done and how she may cooperate. relaxation during the procedure
2.Instruct the women to empty her Avoids discomfort during procedure
abdomen
3.draw curtains around the bed Provide privacy
INSPECTION:-
4,. Position the women for
examination;- Promote relaxation of abdominal
- Place a pillow under her head muscles
muscles and upper shoulders Enables visualization f the whole
- Have her arms by her sides abdomen.
- Expose her abdomen from below
the breasts to the symphysis
pubis.
5.Inspect the abdomen for the
following; scars, hernia, linia nigra,
striae gravidarum, state of umbilicus,
skin condition
6.Determine the fundal height using the In order to estimate if fetal growth
ulnar side of the palm corresponds to the geastational period
-12 weeks: levels of symphisis pubis
-16 weeks- midway between symphysis -12 weeks: levels of symphisis pubis
-20weeks-level of the umbilicuss -16 weeks- midway between symphysis
32 weeks- halfway between umbilicus -20weeks-level of the umbilicuss
and xiphoid process 32 weeks- halfway between umbilicus
-36weeksat level of xiphoid process and xiphoid process
-40weeks- 2-3 fingerbreadths below the -36weeksat level of xiphoid process
xiphoid process if lightening occurs -40weeks- 2-3 fingerbreadths below the
xiphoid process if lightening occurs
7.Measure the fundal height
Using the measuring tape
-place zero line of the tape measure on
the superior border of the symphysis
pubis
Stretch the tape across the counter of
the abdomen to the top of the fundus
along the midline.
8.Measure the abdominal girth by Normally the measurement is 2
encircling the woman abdomen with a inches( 5cm) less than the week of
tape measure at the level of the gestation e.g. 32 inches at 34 weeks
umbilicus gestation.
ABDOMINAL PALPATION OR
LEOPOLD,S MANEUVERS
9. instruct the women to relax her
abdominal muscles by bending her These step the stretching and tension
knees slightly and doing relaxation of abdominal muscles
breathing
10. be sure your hands warm before
beginning to palpate , rest your hand Cold hands may cause muscle
on the mother’s abdomen lightly while contraction and discomfort. Resting
giving explanation about the hands on mother’s abdomen would
procedure. help her to her become accustomed to
your touch and dissipate muscles
11. for the technique of palpation tighteching
Use the flat palmer surface of fingers These measures would aid in gathering
and not fingers tips. Keep fingers of greatest amount of information with
hands together and apply smooth deep least discomfort to the women.
pressure as firm s is necessary to obtain
accurate findings.
12.Perform the first manoeuvre
fundal palpation)
- Face the woman’s head
- Place your hands on the sides of Round , hard, movable part, ballotable
the fundus and curve the figure between the fingers of both hands is
around the top of the uterus indicative of head
- -palpate for size , shape,
consistency , and mobility of the
fetal part in the fundus.
13. Do the second maneuver:-
- continue to face the women’s head
-place your hands on both sides of the A firm covex , continuously smooth and
uterus about midway between the resistance mass extending from breech
symphysis pubis and the fundus. to neck is indicative of fetal back . small
- apply pressure with one hand against knobby , irregular mass, which move
the side of the uterus pushing the fetus when, pressed or may kick or hit your
to the other side and stabilizing it there. examining hands is indicative of the
-palpate the other side of the abdomen fetal small parts all over the abdomen
with the examining finger from the the abdomen are indicative of a
midline to the lateral side from the posterior position.
fundus using smooth pressure and
rotator movements
- repeat the procedure for examination
of opposite side of the abdomen.
14. Third manever(pawlik,s grip)
-continue to face the woman’s head Avoids discomfort
and make sure the woman has her
knees bent. If the fetal head is above the brim, it
Grasp the position of the lower will be readily movable and ballotable.
abdomen immediately above the If not readily movable, it is indicative of
symphysis pubis between movable, it is an engaged head.
indicative of an engaged head, the
thumb and middle finger of one of your
hands.
15. fourth maneuver (pelvic palpation)
-turn and face the womens feet (make Avoids pain with the maneuver
sure the woman knees are bent)
-place your hands on the side of the
uterus, with the palm of your hands just
below the level of umbilicus and your
fingers directed towards the symphysis Cephalic prominence on the same side
pubis. as the fetal small part indicates vertex
-press deeply with ypur finger tips into presentation with well-flexed head
the lower abdomen and move them Cephalic prominence in the same side
toward the pelvic inlet. as the fetal back may be occiput in a
- the hands coverage around the face presentation with extended head
presenting part when head is not
engaged.
-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 and
over the convex portion of the fetus Fetal heart sounds are heard over fetal
closest to the anterior wall back (scapula region) in vertex and
17. inform the mother of your findings. breech presentation. Over chest in face
Make her comfortable. presentation’
18. Replace articles and wash hands.
19. Record in the patient’s chart the
time, findings and remark if any.
 CONCLUSION

Antenatal care refers to the care given to an expectant mother from the time to
conception is confirmed until the beginning of labour. It includes the monitoring
the progress of pregnancy.