Abdominal Exam of Gravid Uterus

Last updated 20.09.12

 

Definition

-  Examination of the gravid uterus by paplaption of the abdomen during pregnancy

 

Features

-  Part of Obstetric Examination at every antenatal visit

-  Visual, fundal, lateral, pelvic & auscultation

-  +/- pt to empty bladder prior to exam

-  Await time between contractions

-  Often done in conjunction with CTG (if appropriate)

 

Indications

-  Pregnancy

-  Labour

 

Patient

-  Supine

-  Abdomen exposed

 

Equipment

-  Tape measure

 

Procedure

-  Fundal height

-  Fundus to pubic symphysis

-   Start at variable point = fundus

-  Roughly palpable at umbilicus at 20/40

-  Influenced by full maternal bladder

-  Place numbers on tape down so not influenced

-  Less accurate in

-   Twins, LGA

-   Polyhydramnios, oligohydramnios

-   Uterine fibroids

-   IUGR

-  McDonalds rule: measure in cm = gestation in weeks +/- 1-3cm (weeks)

-   Valid from 24 weeks gestation

-   Less accurate as labour approaches

-  If concerned then US

-  Leopold Manouvres

-  Lie

-   Longitudinal: Cephalic, Breech

-   Transverse

-  Engagement: measure in 5ths

-  5/5: whole head palpated above pelvic brim

-  4/5: 4/5 head above brim

-  3/5: 3/5 head above brim

-  2/5: 2/5 head above brim

-   Widest part of head passed through brim

-   Head engaged

-   1/5: 1/5 head above brim

-  Presentation

-  Descent

-  FHR

 

Fetal Lie

 

 

 

References

 

Pic (lie): womenshealthsimplified.com/1.jpg

3Centres: Symphyseal Fundal Height Measurement, 07/08/2010