SBA - Presentation 2 (d)
Antenatal Check Up:
Abdominal Examination
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
Abdominal Examination
What is the importance of abdominal
examination?
• Monitor progress of pregnancy and fetal growth
• Check for fetal lie and presentation
• Auscultate fetal heart sounds
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Abdominal Examination
What does it include?
• Measurement of fundal height
• Assessment of fetal lie and presentation
• Assessment of fetal movement
• Auscultation of fetal heart sounds
• Inspection for scars
• Other relevant abdominal findings
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Preparation for abdominal examination
• Ensure privacy
• Examination room should be well lit and airy
• Woman is asked to empty her bladder
• Explain the women about the procedure/process
• To make her comfortable, keep talking to her
• She lies supine with legs partially flexed
• Stand on her right side
• Palpate the uterus with warm hands
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Significance of fundal height
Indicates
• Duration of pregnancy
• Fetal growth
• Any abnormality in the pregnancy
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Assessment of fundal height
•
Keep the ulnar border of
curved left hand on
woman’s abdomen parallel
to symphysis pubis
•
Start from xiphisternum and
gradually proceed towards
symphysis pubis lifting the
hand between each step till
a bulge / resistance of
uterine fundus is felt
•
Mark the level of fundus
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How will you estimate gestational
age from fundal height?
Measurement of fundal height
•
•
•
Divide the abdomen by an
imaginary lines passing
through umbilicus
36 wk
40 wk
Divide the lower abdomen in 3
parts with 2 equidistant lines
between the pubic symphysis
and the umbilicus
Divide the upper abdomen
into 3 parts again with 2
imaginary equidistant lines
between the umbilicus and
xiphisternum
Xiphisternum
32 wk
28 wk
24 wk
Umbilicus
20 wk
16 wk
Pubic symphysis
(Uterus becomes an
abdominal organ
after 12 weeks)
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Measuring Fundal Height
• Measure the distance from the upper border of
symphysis pubis along the uterine curvature to the top
of the fundus with a tape.
• Gestational age in weeks corresponds to the fundal
height in cms from 24 weeks to 30 weeks
• Refer to MO (with referral slip) if
Disparity between the fundal height and gestational
age is > 3 cm
or
No increase in fundal height on subsequent visit
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What are the reasons of fundal height more
than the period of gestation?
• Wrong date of LMP
• Full bladder
• Multiple pregnancy
• Large baby
• Polyhydramnios
• Hydrocephalous
• Hydatidiform mole
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What are the reasons of fundal height less than
the period of gestation?
• Wrong date of LMP
• Intra-uterine growth restriction (IUGR)
• Missed abortion
• Intrauterine death ( IUD)
• Transverse lie
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Fetal lie and presentation
• Examine after 32 wks pregnancy (after this period
the lie usually remains the same till delivery)
• Palpate for fetal lie and presentation
• Normal lie is longitudinal with cephalic
presentation
• Abnormal lie and presentation should be
referred to FRU with referral slip
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Abdominal palpation:
Four grips
• Fundal grip
• Lateral grip
• Superficial pelvic grip
• Deep pelvic grip
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Fundal Palpation / Fundal Grip
Helps to determine lie and presentation of fetus
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Lateral Palpation / Lateral Grip
Helps to locate fetal back
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First Pelvic Grip / Superficial Pelvic Grip
• Helps to determine whether head or breech is
presenting at pelvic brim
• Whether the presenting part is engaged / fixed / free
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Second Pelvic Grip / Deep Pelvic Grip
Helps to know the degree of flexion of head
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Foetal movements
• Fetal movement are reliable sign of foetal well - being
• These are felt around 18-22 wks of pregnancy (felt earlier
in multigravida than primigravida)
• Normally 10-12 foetal movements should be felt by the
pregnant woman in a day
• Decreased foetal movements may be an indication of
foetal distress
• Pattern of foetal movement may change prior to labour
due to reduced space
• If Foetal Movements are absent or not felt, consult ANM or
doctor
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Fetal heart sound (FHS) and rate (FHR)
• FHS is heard per abdomen by stethoscope /
fetoscope after 24 weeks of pregnancy
• Normal FHR is 120 – 160 beats per min
• FHR < 120 beats per min or > 160 beats per min
: Indicates fetal distress and calls for referral
• Confirm that you are listening to the FHS and not
maternal pulse
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Auscultation of FHS
•
Use a fetoscope or stethoscope
•
Best heard on the side of the
back of the fetus
•
In vertex presentation FHS is
best heard midway between
the line joining the umbilicus
and the anterior superior iliac
spine on the side of the back
•
In breech presentation FHS is
heard above the umbilicus
•
Count the FHS for one full
minute (FHR)
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Suspicion of multiple pregnancy on
abdominal examination
• An unexpectedly large uterus for the estimated
gestational age
• Multiple fetal parts felt on abdominal palpation
• FHS is heard at more than one place
Refer the woman to FRU with referral slip and arrange for
institutional delivery
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To summarize
Abdominal examination is done for :
• Fundal height
• Fetal lie and presentation
• Fetal movement
• Fetal heart sounds
• Any other abdominal finding
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Thank you
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