Performing an Antenatal Abdominal Examinationand PalpationDEFINITIONExamination of a pregnant

woman to determine the normalcy of fetal growth in relation to the gestational age, Dosit

of the fetus in uterus and its relationship to the maternal pelvis.tionPURPOSES1. To measure the
abdominal girth and fundal height.

To determine the abdominal muscle tone.2.3. To determine the fetal lie, presentation, position, variety
(anterior or posterior) and engagement.

4. To determine the possible location of the fetal heart tones.

5. To observe the signs of pregnancy.

6. To detect any deviation from normal.ARTICLES1. Fetoscope/stethoscope/Doppler machine.

2. Measuring tape/Pelvimeter.PROCEDURERationaleNursing actionReduces anxiety and promotes

relaxation during

the procedure.1. Explain to the woman what will be done and how she may cooperate.Avoids
discomfort during palpation.2. Instruct the woman to empty her bladder.Provides privacy.3. Draw
curtains around the bed.INSPECTIONPromotes relaxation of abdominal musciesPosition the woman for
examination.

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

b. Have her arms by her side5

Expose her abdomen from below the breasts to the symphysis pubis. Enables visualization of the whole
abdomen5. Inspect abdomen for the following:

Scars, diastasis recti, hernia, linea nigra, striae gravidarum, contour of

the abdomen, state of umbilicus, skin condition.Determine the fundal height using the ulnar side of the
palm [Figure

14.1(a)]. [Table 14.1.1].Provides an estimate whether fetal groweh

corresponds to gestational period.

Nursing actiona. 12 weeks-level of symphysis pubis

b. 16 weeks-midway between symphysis pubis and umbilicus

20 weeks-1-2 finger breadths below umbilicusC

d. 24 weeks-Level of umbilicuse. 28 weeks-3 finger breadths above the umbilicus (1/3rd of the way

e.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 [Figure 14.1(b)]

Measure fundal height using any one of the following methods:a. Using measuring tape [Figure 14.1 (c1.

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

Stretch the tape across the contour of the abdomen to the top of

the fundus along the midline.Figure 14.1(c): Measuring fundal heightb. Caliper method
(Pelvimeter)Place one tip of the caliper on the superior border of the

ymphysis pubis and the other tip at the top of the fundus

Both placements are in the midline.

Ree fneasurement on the centimeter scale located on the arc

Close to the joint. The number of centimeters should be equal.

Nursing action8. Measure the abdominal girth by encircling the woman's abdomen witn

a tape measure at the level of the umbilicus [Figure 14.1(d)].Figure 14.1(d): Measuring abdominal
girthABDOMINAL PALPATION OR LEOPOLD'S MANEUVERSInstruct the woman to relax her abdominal
muscles by bending her

9knees slightly and doing relaxation breathing.10.Be sure your hands are warm before beginning to
palpate, rest yourhand on the mother's abdomen lightly while giving explanation aboutthe
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 firmas is necessary to obtain accurate
findings.12.Perform the first maneuver (Fundal palpation) [Figure 14.1(e)()]a. Face the woman's
head.a.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 inthe fundus.

Do the second maneuver (lateral palpation) [Figure 14.1 (e)(i)]

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.Third maneuver (Pawlik's grip) [Figure 14.1(e)(ii)]

14a. Continue to face the woman's head, make sure the woman has herknees 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) [Figure 14.1(e)(iv)]

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

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 directedtoward the symphysis pubis.

C. Press deeply with your Tingertips into the lower abdomen and movethem toward the pelvic inlet.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.d. The hands converge around the
presenting part when head is notengaged.AUSCULTATIONof the fetus,Place fetoscope or stethoscope
over the convex portion of the fetus,16.closest to the anterior uterine wall [Figure 14.1(f)

Nursing action17. Inform the mother of your findings. Make her comfortable.18. Replace articles and
wash hands.19Record in the patient's chart the time, findings and remarks, if any.

Table 14.1.1: Location of the maximum intensity of the fetal heart tonesPLPresentation and positional
varietiesLocation1. CephalicMidway between umbilicus and level of anterior superior iliac spine2.
BreechLevel with or above umbilicus..AnteriorClose to the abdominal midline.4 Transverse
5 PosteriorIn lateral abdominal area.In flank area.Note1. 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.