Definition
Abdominal 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
- To measure the abdominal girth and fundal height.
- To determine the abdominal muscle tone.
- To determine the fetal lie, presentation, position, variety (anterior or posterior), and engagement.
- To determine the possible location of the fetal heart tones.
- To observe the signs of pregnancy.
- To detect any deviation from normal.
Articles
- Fetoscope/stethoscope/Doppler machine.
- Measuring tape/pelvimeter.
Procedure
| Nursing actions | Rationale | |
| 1. | Explain to the woman what will be done and how she may cooperate. | Reduces anxiety and promotes relaxation during the procedure. |
| 2. | Instruct the woman to empty her bladder. | Avoids discomfort during palpation. |
| 3. | Draw curtains around the bed. | Provides privacy. |
| 4. | Inspection Position the woman for examination. | |
| Place a pillow under her head and upper shoulders. | Promotes relaxation of abdominal muscles. | |
| Have her arms by her sides. | Enables visualization of the whole abdomen. | |
| Expose her abdomen from below the breasts to the symphysis pubis. | ||
| 5. | Inspect abdomen for the following: Scars, diastasis recti, hernia, linea nigra, striae gravidarum, contour of the abdomen, state of umbilicus, skin condition. | |
| 6. | Determine the fundal height using the ulnar side of the palm. 12 weeks-level of symphysis pubis. 16 weeks-midway between symphysis pubis and umbilicus. 20 weeks-1-2 finger breadths below umbilicus. 24 weeks-level of umbilicus. 28 weeks-3 finger breadths above the umbilicus (one-third of the way between umbilicus and xiphoid process). 32 weeks-halfway between umbilicus and xiphoid process. 36 weeks– at level of xiphoid process. 40 weeks-2-3 finger breadths below the xiphoid process, if lightening occurs. | Provides an estimate whether fetal growth corresponds to gestational period. |
| 7. | Measure fundal height using any one of the following methods: a. Using measuring tape. Place zero line of the tape measure on the superior border of symphysis pubis. Stretch the tape across the contour of the abdomen to the top of the fundus along the midline. | The number of centimeters measured should be approximately equal to the weeks of gestation after about 22 to 24 weeks. |
| b. Caliper method (Pelvimeter) Place one tip of the caliper on the superior border of the symphysis pubis and the other tip at the top of the fundus. Both placements are in the midline. Read the measurement on the centimeter scale located on the arc, close to the joint. The number of centimeters should be equal. | This method is more accurate. | |
| 8. | Measure the abdominal girth by encircling the woman’s abdomen with a tape measure at the level of the umbilicus. | Normally the measurement is 2 inches (5 cm) less than the weeks of gestation, e.g. 32 inches at 34 weeks gestation. Measurements more than 100 cm (39 and a half inches) is abnormal at any week of gestation. |
| Abdominal palpation or Leopold’s maneuvers | ||
| 9. | Instruct the woman to relax her abdominal muscles by bending her knees slightly and doing relaxation breathing. | These steps reduce the stretching and tension of abdominal muscles. |
| 10. | Be sure your hands are warm before beginning to palpate, rest your hand on the mother’s abdomen lightly while giving explanation about the procedure. | Cold hands may cause muscle contraction and discomfort. Resting hands on mother’s abdomen would help her to become accustomed to your touch and dissipate muscle tightening. |
| 11. | For the technique of palpation: Use the flat palmar surface of fingers and not fingertip. Keep fingers of hands together and apply smooth deep pressure as firm as is necessary to obtain accurate findings. | These measures would aid in gathering greatest amount of information with least discomfort to the women. |
| 12. | Perform the first maneuver (fundal palpation). | |
| Face the woman’s head. | ||
| Place your hands on the sides of the fundus and curve the fingers around the top of the uterus. | ||
| Palpate for size, shape, consistency, and mobility of the fetal part in the fundus. | Round, hard, readily movable part, ballotable between the fingers of both hands is indicative of head. Irregular, bulkier, less firm and not well-defined or movable part is indicative of breech. Neither of the above is indicative of transverse lie. | |
| 13. | Do the second maneuver (lateral palpation) | |
| Continue to face the woman’s head. | A firm convex, continuously smooth and resistant mass extending from breech to neck is indicative of fetal back. Small knobby, irregular mass, which moves when pressed or may kick or hit your examining hand is indicative of the fetal small parts. Small parts all over the abdomen are indicative of a posterior position. | |
| Place your hands on both sides of the uterus about midway between the symphysis pubis and the fundus. | ||
| Apply pressure with one hand against the side of the uterus pushing the fetus to the other side and stabilizing it there. | ||
| 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. | ||
| Repeat the procedure for examination of opposite side of the abdomen. | ||
| 14. | Third maneuver (Pawlik’s grip) | |
| Continue to face the woman’s head (make sure the woman has her knees bent). | Avoids discomfort. | |
| Grasp the portion of the lower abdomen immediately above the symphysis pubis between the thumb and middle finger of one of your hands. | If the fetal head s above the brim, it will be readily movable and ballotable. If not readily movable, it is indicative of an engaged head. | |
| 15. | Fourth maneuver (pelvic palpation) | |
| Turn and face the woman’s feet (make sure the woman’s knees are bent). | Avoids pain with the maneuver. | |
| Place your hands on the sides of the uterus, with the palm of your hands just below the level of umbilicus and your fingers directed toward the symphysis pubis. | This maneuver determines level of engagement. | |
| Press deeply with your fingertips into the lower abdomen and move them toward the pelvic inlet. | ||
| The hands converge around the 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 into the pelvic inlet. | ||
| Auscultation | ||
| 16. | Place fetoscope or stethoscope over the convex portion of the fetus, closest to the anterior uterine wall. Fetal positions: ROA: Right occiput anterior. LOA: Left occiput anterior. RSP: Right sacrum posterior. LSP: Left sacrum posterior. RSA: Right sacrum anterior. LSA: Left sacrum anterior. | Fetal heart sounds are heard over fetal back (scapula region) in vertex and breech presentation. Over chest in face presentation. |
| 17. | Inform the mother of your findings. Make her comfortable. | |
| 18. | Replace articles and wash hands. | Reduces transfer of microorganisms. |
| 19. | Record in the patient’s chart the time, findings, and remarks, if any. | Promotes communication among staff. |
Special Considerations
- Pelvic palpation may be performed as the third maneuver before performing Pawlik’s grip to feel the cephalic prominence and to confirm the presentation.
- Pawlik’s grip as the third 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 (fourth maneuver) without taking her hands off the mother’s abdomen.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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