Introduction
Introduce yourself
Wash Hands
Ask if patient has any pain anywhere before you begin
Explanation
Describe what you are going to do
“I would like to perform an examination by gently feeling your tummy. Although it may be a little uncomfortable, it should not be painful” .Gain consent
“Is that ok?” .Get a chaperone!!
“By law i’m required to have a female chaperone present, is that ok?” “Do you need to empty your bladder before i examine you?”Inspection
Position patient to the supine position
Expose abdomen from xiphisternum to the pubic symphysis
Inspect the abdomen
Asymmetry
Foetal Movements
Surgical Scars
Cutaneous Signs of Pregnancy:
- Linea Nigra
- Striae Gravidarum
- Striae Albicans
Palpation
Ask about tenderness before starting!
Measure symphyseal-fundal height
- Palpate using ulnar border of left hand moving from sternum downwards
- Locate the fundus of the uterus (firm feeling)
- Locate upper border of pubic symphysis
- Measure distance in cm
- The distance should correlate with gestational age (+/- 2cm)
Determine foetal lie
Fundal Palpation
Do this with both hands to identify which pole of foetus is at fundus
Lateral Palpation
Palpate either side of uterus, moving down to determine where the fetal back lies
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Pelvic Manoeuvre
Turn to face patients feet
Press down on either side of lower uterus to determine presenting part
The head will be ballotable (be gentle)
How many 5th’s palpable?
Foetal head is divided into fifths in the coronal plane
If you are able to feel the entire head in the abdomen it is 5/5th’s palpable (not engaged)
If you are not able to feel the head at all abdominally it is 0/5th’s palpable (fully engaged)
Auscultation
Use a Pinard’s stethoscope
You have already identified the fetuses back
Place over anterior fetal shoulder (scapulae)
To complete the examination
Re-cover patient - allow patient to re-dress in privacy
Thank Patient
Wash Hands
Summarise Findings - “fundal heigh is 36cm which is in keeping with the current gestation. The foetus is in a longitudinal lie, with cephalic presentation, 2/5th’s palpatable with a regular heart rate”
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