ANTENATAL ABDOMINAL

EXAMINATION

PRESENTED BY:
MADHURI PRAKASH.R
LECTURER
DEPT.OF OBG
 INTRODUCTION

A through and systemic abdominal examination

beyond 28 weeks of pregnancy can reasonably
diagnose..,
1. The lie
2. Presentation of the fetus
3. Position,
4. And attitude of the fetus.
It is not unlikely that the position o fthe fetus might
change, especially in association with excess liquor
amnii and hence periodic check up is essential.
 PRELIMINARIES

verbal consent for examination is taken.

the patient is asked to evacuate the bladder.{A full
bladder will make the examination uncomfortable
and can reduce the accuracy of the fundal height
measurement}
she is then made to lie in dorsal position with thighs
slightly flexed.[The woman should be encouraged to
lie with her arms by her sides to aid relaxation of the
abdominal muscles.]
Place a wedge under the right buttock if the gravid
uterus is of a size likely to compromise maternal
and/or fetal circulation.[Pelvic tilt prevents
occurrence of supine hypotension resulting from the
weight of the gravid uterus obstructing the inferior
vena cava reducing venous return and hence
cardiac output.]
abdomen is fully exposed.
the examiner stands on the right sid of the patient.
 INSPECTION

Note the abdominal size. A full bladder, distended colon, or

maternal obesity may effect estimation of
fetal size

Observe the abdominal shape. An abdominal shape that is longer than

it is wide indicates a longitudinal lie.
However, a shape that is low and broad
may point to a transverse lie.
The primigravid uterus is ovoid in
shape compared to the multigravid
uterus, which is a rounded shape.
Dips and curves in the uterus may
indicate fetal position
Inspect the abdomen for Presence of scars may indicate previous
scars. abdominal or obstetric surgery

Examine the skin. Hormonal influences in pregnancy can cause

striae gravidarum, hyperpigmentation, changes
in nails, hair, and the vascular system.
Striae gravidarum caused by physical and
hormonal influences is more common in
younger women, those with higher body mass
indices, and in women carrying larger babies.

Observe for fetal Visible external fetal movements may be visible

movements.
 PALPATION

Estimating Palpate of the abdomen by using the physical

gestational age landmarks of the xiphisternum, the umbilicus and
the symphysis pubis.
Macrosomia, multiple pregnancy and small for
gestation age may be detected by palpation and
measurement of fundal height.
Current evidence does not indicate that either the
palpation method, or measurement of fundal height
method, is superior to each other for detection of
abnormal fetal growth.
If a small for gestational age fetus is suspected, then
confirmation of the estimated gestational age should
be revisited.
Measure the fundal Between 20 to 34 weeks gestation the height of the
height with the tape uterus correlates closely with measurements in
measure from 24 weeks centimetres, however maternal obesity has been
gestation. shown to distort the accuracy of these
measurements
 FUNDAL PALPATION

Both hands are gently placed Aids determination of presentation,

around the fundus to whether cephalic or breech. This will aid
determine contours of the diagnosis of the lie and presentation of the
fetus. fetus.

The whole of the fundal area is palpated using both hands laid flat on it to
find out which pole of the fetus is lying in the fundus.
Broad,soft and irregular mass suggestive of breech.
Smooth,hard and globular mass suggestive of head.
In transverse lie, neither of the fetal poles are palpated in the fundal area
 LATERAL PALPATION

Hands are placed at umbilicus level on either Location of the fetal

side of the uterus. Gentle pressure is used with back can help determine
each hand to determine which side offers the the fetal position.
greatest resistance. Walking the fingers over
the abdomen can also locate the position of the
back and distinguish fetal body parts.

The back is suggested by smooth curved and resistent feel.

The limb side is comparatively empty and there are small knob like irregular
parts.
After idetification of the back,it is essential to note its position whether placed
anteriorly or towards the flank or placed transversely.
Similarly the disposition of the smaller parts are also to be noted.
 PELVIC PALPATION

Pelvic Palpation Ask the A woman in a relaxed

woman to bend her knees position is less likely to tense
slightly and encourage gentle abdominal muscles.
breathing exercises.
PAWLIKS GRIP/THIRS LEOPOLD

The examination is done facing towards the patients face.

The overstretched thumb and four fingers of the right hand are
placed over the lower pole of the uterus keeping the ulnar
border of the palm on the upper border of the symphysis pubis.
When the fingers and the thumb are approximated,the
presenting part is grasped distinctly[if not engaged] and also
the mobility from side to side id tested.
In transverse lie the pawliks grip is empty.
PELVIC GRIP/FOURTH LEOPOLD

The examination is done facing the patients feet.

Four fingers of both the hands are placed on the either side of
the midline in the lower pole of the uterus and parellel to the
inguinal ligament.
The fingers are pressed downward and backward in a manner
of approximation of finger tips to palpate the part occupying
the lower pole of the uterus.
If it is head,the charecteristics noted are..,
1. Precise presenting part
2. Attitude and
3. engagement
 To ascertain the presenting part, the greater mass of the
head[cephalic prominence] is carefully palpated and its relation
to the limbs and the back is noted.
The ATTITUDE of the head is inferred by noting the relative
position of the sincipital and occipital poles.
The ENGAGEMENT is ascertained noting the presence or
absence of the sincipital and the occipital pole or whether there
is convergence or divergence of the finger tips during palpate.
 AUSCULTATION

Auscultation of distinct fetal heart sounds not only helps in the

diagnosis of the live baby, but its location of maximum
intensity can also resolve doubt about the presentation of the
fetus.
The FHR are best audible through the back in vertex and
breech presentation, where the concave portion of the back is
in contact with the uterine wall.
As a rule, the maximum intensity is below the umbilicus in
cephalic presentation and around the umbilicus in breech.