Abdominal Palpation in Pregnancy

Image by Øyvind Holmstad (Own work) [CC BY-SA 4.0 (http://creativecommons.org/licenses/by-sa/4.0)], via Wikimedia Commons

Abdominal Palpation in Pregnancy

Abdominal examination in pregnancy comprises of four steps such as

• Inspection
• Palpation 
• Percussion
• Auscultation

Preparation of the patient

• Ask the mother to empty the bladder
• Check height, weight and blood pressure of the mother
• Position the patient in supine position at an angle of 30 degree
• Provide privacy
• Expose the abdomen from below chest to symphysis pubis and keep a drape sheet to cover the abdomen when you are not examining her
• Stand on the right side of the mother and warm up your hands

Inspection

Remember 'SSSFU' during inspection of the abdomen which means size, scars, skin changes, fetal movements and umbilicus.

Size and shape of the uterus should be appropriate to the gestational age and symmetrical. It might be in round or ovoid in shape.

Transverse scars, laparoscopic or laparotomy scars indicates previous surgeries including LSCS.

Skin changes includes striae gravidarum, striae albicantes and linea nigra.  Striae gravidarum is caused by hormonal changes and appears early in prenancy.  Striae albicantes are stretch marks from previous pregnancies. Linea nigra is a dark coloured straight line from below chest to symphysis pubis.

Fetal movements are visible from 24 weeks which indicates viability.

Umbilicus  may become flattened.

Palpation

Before proceeding into palpation, measure abdominal girth in inches or centimeters by keeping a inch tape around the abdomen. Then, palpate the fundus by ulnar border of the left hand and measure the gestational weeks using fingerbreadth method. Up to umbilicus, it is to be considered as 24 weeks. Keep four fingers of right palm above the umbilicus and measure it by considering one finger width is one week.

To measure the fundal height, keep the inch tape from symphysis pubis to fundus. The fundal height in centimeters is equal to gestation weeks with a difference up to +/-3 cm.

1. Fundal grip- Palpate the superior border of the fundus by using palms of two hands determine the pole of the fetus.
2. Lateral grip- Palpate the lateral sides of the abdomen to determine the spine and limbs of the fetus. If the fetus lies at a right angle to the axis of the uterus, it is in a transverse lie. If the head and buttocks are palpable on lateral sides, it indicates the fetus is in a oblique lie.
3. Pelvic grip-Turns into foot end of the patient and move both of your hands from lateral sides to pubis. If the hands are converged, it indicates head is not engaged. If the hands are not converged, it indicates engaged head.
4. Pawlick grip-  Grasp the lower portion of the abdomen using the fingers and thumb of the right hand to feel the ballotment of the head, which indicates the floating head and the progress of the labour.

Percussion

This technique can be used in mothers with polyhydramnios.

Auscultation

Fetal Heart Sounds (FHS) can be heard by fetoscope/ stethescope/ hand held doppler monitor. The fetal heart rate is normally between 110 and 160 b.p.m.