ABDOMINAL ASSESSMENT

• Abdomen assmt provide information about uterine growth and confirm EDD/EDB

• 12 weeks – uterus above symphysis pubis,• 16 week – between symphysis pubis and

umbilicus• 20 weeks – at umbilicus• 36 weeks – at xiphoid process• 40 weeks – fetal head x pelvic cavity called

lightening.Therefore uterus sinks

Mac Donald Method

1. Women Lies on her back (trunk elevated) with knee flexed

2. Top of fundus palpated and tape stretched from top of symphysis pubis over abdominal curve to the top of fundus.

From 22 weeks to term fundal height roughly equals + or – 2 cm to the gestational age of foetus in weeks.

Second & Third trimester

• McDonald’s rule :

Height of fundus (in Cm) x 8/7 =Duration of pregnancy in weeks

Eg: If fundal height = 22cm X 8/7 =

25weeks

Leopold’s ManeuvarStand beside the women, facing her head with dominant

hand near her First Maneuver

A) Palpate uterine fundus

Distinguish betweenCeaphalic and breech(buttocks) presentation– breach is softer andirregular in shape thanhead.The head is harder,round and uniformshape.

Second Maneuver

A) Hold left hand steady on one side of the uterus while palpating the opposite side of the uterus with the right hand.

B) Hold the right hand

steady while palpating opposite side of uterus with left hand.

To determine which

side is the fetal back

on and which side the

arms and legs (small

parts) are on.

Fetal back is smooth,

convex surface. Fetal

arms and legs feel

nodular.

Third ManeuverA) Palpate the

suprapubic area

B) Grasp the presenting part gently between thumb and finger

To confirm the presentationfelt in the first maneuverand to determine ifpresenting part is engaged.

If a breach was palpated inthe fundus, expect a hardround head in this area.If the presenting part is notengaged, grasping with thefinger moves it upwards inthe uterus.

Fourth Maneuver

Done only if the fetus is

In ceaphalic presentation

A)Turn so as to face the

womans feet, place

hands on each side of

the uterus with

fingers pointed towards

pelvic inlet

To determine whether

head is flexed (vertex) or

extended (face)

B) Slide hands downward

on each side of the

uterus, on one side the

fingers should slide to

upper edge of symphysis,

On other side, your fingers

meet an obstruction, the

cephalic prominence

If head is flexed,ceaphalic prominence(forehead) is felt onopposite side from fetalback, if head isextended, the ceaphalicprominence (occiput) isfelt on the same side asthe fetal back.

Auscultating fetal heart rate

• Purpose – To evaluate fetal condition and tolerance of labour

1.Explain

2.Wash hands (using warm water)

3.Use leopold’s maneuver – Identify back ---it is close to maternal abdomen, were fetal heart sound is clear

Equipments to assess FHR

• Fetoscope

• Doppler transducer (place H2o soluble gel over transducer to make interface for clear signal transmission. Place transducer over fetal back and move it till you hear FHS