Contents
ObjectivesWhen you have completed this skills chapter you should be able to: Show
General examination of the abdomenThere are two main parts to the examination of the abdomen:
A. Preparation of the patient for examination
B. General appearance of the abdomenThe following should be specifically looked for and noted:
C. Palpation of the abdomen
Examination of the uterus and the fetusD. Palpation of the uterus
E. Determining the size of the uterus before 18 weeks gestation
F. Determining the height of the fundus from 18 weeks gestationThe symphysis-fundus height should be measured as follows:
Having determined the height of the fundus, you need to assess whether the height of the fundus corresponds to the patient’s dates, and to the size of the fetus. From 18 weeks, the SF height must be plotted on the SF growth curve to determine the gestational age. This method is, therefore, only used once the fundal height has reached 18 weeks. In other words, when the SF height has reached 2 fingers width under the umbilicus.
G. Palpation of the fetusThe lie and presenting part of the fetus only becomes important when the gestational age reaches 34 weeks. The following must be determined:
H. Methods of palpationThere are four specific steps for palpating the fetus. These are performed systematically. With the mother lying comfortably on her back, the examiner faces the patient for the first three steps, and faces towards her feet for the fourth.
I. Special points about the palpation of the fetus
J. Special points about the palpation of the fetal head
K. Assessment of the amount of liquor presentThis is not always easy to feel. The amount of liquor decreases as the pregnancy nears term. The amount of liquor is assessed clinically by feeling the way that the fetus can be moved (balloted) while being palpated.
In many cases, however, the cause of polyhydramnios is unknown. However, serious problems can be present and the patient should be referred to a hospital where the fetus can be carefully assessed. The patient needs an ultrasound examination by a trained person to exclude multiple pregnancy or a congenital abnormality in the fetus. L. Assessment of uterine irritabilityThis means that the uterus feels tight, or has a contraction, while being palpated. Uterine irritability normally only occurs after 36 weeks of pregnancy, i.e. near term. If there is an irritable uterus before this time, it suggests either that there is intra-uterine growth restriction or that the patient may be in, or is likely to go into, preterm labour. M. Listening to the fetal heart
N. Assessment of fetal movementsThe fetus makes two types of movement:
When you ask a patient to count her fetal movements, she must count both types of movement. If there is a reason for the patient to count fetal movements and to record them on a fetal-movement chart, it should be done as follows:
Table 1B-1: Chart for recording fetal movements
The chart records that:
Every time the fetus moves, the patient must make a tick on the chart so that all the movements are recorded. The time and day should be marked on the chart. If the patient is illiterate, the nurse giving her the chart can fill in the day (and times if the chart is to be used more than once a day). It is important to explain to the patient exactly how to use the chart. Remember that a patient who is resting can easily fall asleep and, therefore, miss fetal movements. O. Assessment of the state of fetal wellbeingIt is very important to assess the state of fetal wellbeing at the end of every abdominal palpation. This is done by taking into account all the features mentioned in this skills chapter. When is the uterus at the xiphoid process?The placenta provides a crossing point between the developing fetus and maternal circulation. In pregnancy, the uterus hypertrophies to accommodate the growing fetus. It typically reaches the height of the umbilicus at 20 weeks and the xiphoid process at 38 weeks.
Where should the fundus be at 12 weeks?The location of your fundus moves as your pregnancy progresses. At about 12 weeks in pregnancy, your fundus is in almost the same spot as your pubic bone. By the time you reach 20 weeks, your fundus is at your belly button.
Where is the fundus at 14 weeks?Box 10.1 Changes in fundal height in a normal pregnancy
At about three months (13-14 weeks), the top of the uterus is usually just above the mother's pubic bone (where her pubic hair begins). At about five months (20-22 weeks), the top of the uterus is usually right at the mother's bellybutton (umbilicus or navel).
How do you calculate gestational age from fundal height?How to calculate gestational age from fundal height?. We may use the McDonald's rule for fundal height by week: At 12 weeks, the uterus' fundus is located just above the pubic bone. ... . We may also use the formula: GA = 6.5858 - 2.7073 * √SFH + (1.2952 * SFH) ,. |