Antenatal Palpation.

Carole Baker

Rationale for Antenatal Palpation

Assess fetal growth, size and wellbeing. Locate fetal position and presentation. Detect deviations from the norm.

Indications for Antenatal Palpation.

Each antenatal assessment. On admission to hospital for any reason. Prior to invasive screening tests i.e. Amniocentesis, induction of labour. Prior to auscultation of the fetal heart and the use of CTG equipment.

Technique Used for Antenatal Palpation

Inspection. Palpation. Auscultation.

Inspection Size May Be Affected By:

Gestational period. Multiple pregnancy. Fetal size. Fetal lie

Obesity Lax uterine muscles Polyhydramnious Oligohydramnious Uterine fibroids

Shape.
May give an indication to the fetal position or presentation. A dip at the umbilicus may be indicative of an occipito-posterior presentation.

Skin Changes
Linea nigra. Striae gravidarum Signs of previous abdominal surgery.

Fetal Movements

Fundal Palpation
Assess the estimated period of gestation by assessing fundal height. Suggest the indication of lie and presentation of the fetus, according to the presence of the fetal pole (head, buttocks).

Lateral Palpation.

Assess the main body of the uterus to identify the fetal position and confirm the lie.

Pelvic Palpation

Pelvic presentation assesses the presentation, i.e. the part of the fetus lying in the lower segment of the uterus or at the pelvic brim.

Pelvic Palpation Continued.

It can then determine: Whether the fetus is flexed. Whether the presenting part has engaged in the pelvis. How mobile or movable the presenting part is if it has not engaged.

Engagement.
Engagement into the pelvis is assessed according to the passage of the widest transverse diameter through the pelvic brim. In a cephalic presentation this is the biparietal diameter (9.5cms). In a primigravida this usually occurs after 36 weeks.

Engagement.
This is generally measured in fifths. The measurement recorded is the amount that is not in the pelvic brim.

Auscultation.
Every examination or after every investigation. The fetal heart sounds are heard through the fetal shoulder. Assess its presence Rate 110-160. Regularity Veriability

Records. (UKCC,1998)
Fundal height Lie Presentation and degree of engagement. Position. Fetal heart rate and the equipment used. Fetal movements felt. Any additional info. i.e. Contractions, scars, liquor volume, (Date Sign & print name)