Abdomen Examination PDF

Clinical Procedures Abdominal Examination Outlines:- 1- Definition 2- Objectives 3- Equipment 4- Preparation of the mother 5- Methods of abdominal examination  Inspection.  Palpation  Auscultation...

Clinical Procedures Abdominal Examination Outlines:- 1- Definition 2- Objectives 3- Equipment 4- Preparation of the mother 5- Methods of abdominal examination  Inspection.  Palpation  Auscultation 27  Clinical Procedures Definition:- It is a visual, tactile and or audible examination of the woman's abdomen. Objectives: 1. To confirm pregnancy 2. To assess fetal size and groth 3. To identify the location of fetal partes 4. To auscultate the fetal heart sounds. 5. To detect any deviation from normal Equipment 1- Pinard fetoscope or sonic fetal heart sound device. 2- Client record. Preparation of the mother:- 1- Instruct the woman to empty her bladder because a full bladder will make the examination uncomfortable and also make the measurements of fundal height less accurate. 2- Instruct the woman to lie on “supine position” on her back to relax the abdominal muscles 3- It is important that the midwife exposes only that area of the abdomen she needs to palpate; and covers the remainder of the woman. 4- Maintain privacy to aid in relaxation of the abdominal wall , the shoulders should be raised slightly on a pillow and the knees drawn up a little Methods of abdominal examination 1- Inspection. 2- Palpation 3- Auscultation 28  Clinical Procedures Steps Rational -Welcome the woman and Explain To obtain verbal consent and the procedure Co-operation -Ensure an empty bladder A Full bladder will cause discomfort and cause wrong fundal height. - provide privacy - Show respect and feeling of self value. -Position her on the examination - To relax abdominal muscles and reduce couch on her back with knees the risk of supine hypotension. slightly flexed and seperated.put pillow under her head and put arms down on her side. -Expose the abdomen fully, To maintain privacy leaving legs and pubic area covered. Inspection -Observe the abdomen for:- -shape and size in relation to the - To get a rough idea about utrine size and period of amenorrhea. muscles tone,fetal lie affects the shape ,also Indicate living fetus and his position. -Skin coditiions are three:- -Inddicate previous surgery specially C.S. I-Scars It is adark brown line from the umblica to the symphsis pubis. 2-Linea-negra It is silver or red patches or lines due to 3- striae-gravidarum found in over stretching of the skin ,found (abdomen,breasts,thighs,and buttocks. -Fetal movements 29  Clinical Procedures Note:- Palpation is done in 3 special Move:ment with warm relaxed hands and arms, using the pads of fingers in smooth movements over the abdomen To avoide discomfort to the woman and causing contraction. *Palpated using four Leopold's - To determine which part of fetus is manoeuvres occupying the fundus. First Maneuver:-Fundal Papation (foetal poles): Facing the woman,s head. Place hands palm and fingers close together on the fundus, using fingers pads palpate the fundus.-A hard smooth, round pole indicates a fetal head. -A softer triangular pole continuous with the fetal body is the fetal buttocks(breech). · Second Maneuver The lateral grip(Fetal lie): -Move both hands in a downward -To determine fetal lie. direction from the fundus along the sides of the uterus. -"Lie" is the relationship between the longitudinal axis of the foetus and the longitudinal axis of the mother. -The "lie" is usually longitudinal, hence baby is lying length- wise in the same direction as mother's longitudinal axis. -Other "lies" are transverse lie (fetus lies across the long. axis of mother) and oblique 30  Clinical Procedures lie (foetus lies at an oblique angle to the mother's long. axis). third Maneuver( Pawlik's grip): -The thumb and middle fingers of -to determine the presenting part. the right hand are placed wide apart over the suprapubic area. -Presenting part of fetus is the lowest most part of the fetus at the inlet of the pelvis(the lower fetal pole as opposed to the fetal pole in the fundus). -Cephalic or breech presentation distinguished from each other. Fourth maneuver (pelvic grip): Determines two points about the fetus 1)The attitude of the fetal head -turn around to face patients feet. -Each hand placed on either side of the fetal trunk lower down. -To detem1ine which fetal part is -The hands moved downwards occupying the lower part of the uterus(the towards the fetal head. presenting part). -Note made as to which hand first touches the fetal head (This point called cephalic prominence). -Cephalic prominence helps 31  Clinical Procedures determine the attitude (i.e. flexion, deflexed or extended) of fetal head. -If cephalic prominence is on the opposite side of fetal back, fetal head is well flexed (normal position). -If cephalic prominence on the same side as fetal back, fetal head is extended (abnormal position). -If examiners hands reach the fetal head equally on both sides, fetal head is deflexed ('Military position, indicating mal-position) 2)Engagement of the fetal head: - Continue moving both hands down around the fetal head, determine how far around the head you can get. - Engagement of the fetal head defined as having occurred once the widest transverse diameter of the fetal head has passed through the pelvic inlet into the true pelvis. - still in the lower abdomen (also called the 'false' pelvis but cannot palpate the part of fetal head in the true pelvis. - If you divide the fetal head into five-fifths, you estimate how many fifths of the fetal head can be felt. - If 5,4 or 3 fifths can still be palpated, most of the head is still up, hence the widest part of the head has not engaged into the pelvis. 32  Clinical Procedures - If only 2,1 or 0 fifths of fetal head felt, the widest part of the head has engaged into the pelvis. Leopold's manoeuvres Auscultation of the foetal heart: - Auscultated with a foetal stethoscope( Pinard's foetal stethoscope) or with a - doptone machine. - Best place to listen is over the foetal back, closer to the cephalic pole. The normal foetal heart rate is btw 110 to 160 beats per minute 33  Clinical Procedures Procedure Checklist: Leopold's Maneuver No. STEPS 2 1 0 1. Define the procedure: It is an assessment done in a detailed systemic order when a pregnant woman attended the antenatal clinic (Inspection-palpation and auscultation). 2. Identify Objective: 1) To determine the presentation and position of the fetus. 2) To determine whether lightening and engagement has occurred. 3) To identify the maximum impulse for auscultation of fetal heart beat. 4) To determine if the fetus is in normal state of flexion. 5) To determine the presence of multiple pregnancy. 6) To estimate fetal size and locate fetal parts. 3. Prepare equipment and Wash hands with warm water. 4. Prepare the woman by: Explain the procedure and Instruct to empty her bladder then instruct the woman to lie on her back, with knees flexed slightly (dorsal recumbent position) Place a small pillow or rolled towel under client's right hip. 5. Close the door or close the curtains. Properly drape the patient. 6. Perform abdominal palpation (Determine fundal level) Stand at the foot of the bed facing the face of the woman and measured in centimeters from the top of pubic bone to the top of fundus, correllates with the current weeks of pregnancy. 7. First Maneuver or fundal grip:( determine the fetal lie and presentation) Stand at the foot of the bed, facing the patient and gently place both hands flat on the abdomen palpate upper abdomen with both hands (Use palms not fingertips). Palpate gently but with firm motions ,determine if the mass palpated is the head or buttocks by observing the relative consistency ,shape ,and mobility 34  Clinical Procedures 8 Second maneuver: Umbilical Grip After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. 9 Third maneuver: Pawlick's Grip In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. The individual performing the maneuver first grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. The Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part. 10 Fourth maneuver: Pelvic Grip The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back. 35