Abdonimal Palpation - how to perform abdo palp and what to look for PDF

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how to perform abdo palp and what to look for ...

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ABDONIMAL P PALP ALP ALPA ATION Assess fetal growth, size, wellbeing, position and presentation and to Detect deviations from the norm

LIE The relationship of the long axis of the fetus (fetal spine) to the long axis of the uterus. -

Longitudinal: relationship between the long axis of the fetus with respect to the long axis of the mother.

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Transverse: is a sideways position. The baby has his head to one of his mother's sides and the bottom across her abdomen at her other side.

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Oblique: when the baby's head is in the mother's hip. The baby's body and head are diagonal, not vertical and not horizontal

ATTITUDE Relationship of the fetal head and limbs to its body

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Fully flexed: This is normal attitude in cephalic presentation.

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Partially flexed (deflexed or military): the fetus head is only partially flexed or not flexed. It gives the appearance of a military person

Completely extended When fetal head is well flexed, smaller AP diameter presents, therefore labour has potential to be more efficient

PRESENTATION The part of the fetus lying in the lower pole Cephalic (vertex)

DENOMINATOR Part of the presentation that determines position (denominator is leading bony part) – Cephalic ‐ denominator is occiput – breech ‐ denominator is sacrum – face – denominator is mentum (chin)

POSITION – Relationship of denominator to six areas of the mother’s pelvis – Left and right anterior – Left and right transverse (lateral) – Left and right posterior – In cephalic presentation the fetal occiput is denominator -

Left or right occipito‐anterior (LOA, ROA) Left or right occipito ‐transverse (LOT, ROT) Left or right occipito‐posterior (LOP, ROP)

FETAL HEAD When the widest transverse (biparietal diameter) has passed through the brim of the pelvis -

If mobile or movable it is not engaged

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Amount of fetal head palpable above the brim

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is assessed and described in fifths

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Engagement is palpable abdominally

5= WELL ENGAGED

METHOD OF ABDO PALP -

Check history (ensure palpation not contra‐indicated )

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Gain permission through informed consent

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Encourage the woman to empty her bladder

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Provide a private environment

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Perform HH, short nails

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Ask woman to lie flat using one pillow, can flex knees

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Face the woman’s face throughout the procedure

LOA: Left occipito anterio anteriorr The occiput (Back of the head) points to the left iliopectineal eminence; the sagittal structure is in the right oblique diameter of the pelvis LOA baby back is on the mother’s left side. The baby faces towards the mother’s back between the right hip and the spine of his or her mother. ROA: Right occipito anterior The occiput points to the right iliopectineal eminence; the sagittal structure is in the left oblique diameter of the pelvis LO LOT T: Left occipito tr transverse ansverse The occiput points to the left iliopectineal line midway between the iliopectineal eminence and the sacroiliac joint; the sagittal suture is in the transverse diameter of the pelvis. When the occiput is towards the mother’s left and baby faces and kicks towards her right side. RO ROT T: Right occipito tr transverse ansverse The occiput points to the right iliopectineal line midway between the iliopectineal eminence and the sacroiliac joint; the sagittal suture is in the transverse diameter of the pelvis when the occiput is towards the mother’s right and baby faces and kicks towards her left side LOP: Left occipito p posterior osterior The occipito points to the left sacroiliac joint; the sagittal suture is in the left oblique diameter of the pelvis ROP: Right occipito posterior The occipito points to the right sacroiliac joint; the sagittal structure is in the right oblique diameter of the pelvis DOA: direct occipito anterior

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The occipito points to the symphysis pubis; the sagittal structure is in the anteroposterior diameter of the pelvis

DOP Direct occipito posterior The occipito points to the sacrum; the sagittal structure is in the antero-posterior diameter of the pelvis In breech and face presentations the positions are described in a similar way using the appropriate

1. Ask if they would like to empty their bladder 2. Inform women “ just going to have a feel of your tummy to see the position of the baby , is that okay” 3. Ask for permission 4. Visual presentation of abdomen: - Size: may be affected by obesity, Polyhydramnios / Oligohydramnios, Multiple pregnancies. - Shape: may give an indication of the fetal position or presentation, eg, a dip at the umbilicus can be indicative of an occipito-posterior position - Skin: Linea nigra (Dark line), Stria Gravidarium (Stretch marks), signs of previous abdominal surgery, Rash or itching - Fetal movements: May be seen - Signs of potential domestic violence may be observed 5. Locate fundus > using hands nearest to the women, the pads of the fingers are placed on the abdomen below the Xiphisternum (Lowest part of sternum) and moved gently downwards until the firmness of the fundus is felt 6. Locate Symphysis Pubis> Place measuring tape 0cm on upper boarder on Symphysis Pubis , running it through the midline of the abdomen to the top of the fundus = The centimetres equates generally how many weeks gestation, margin of error of + 2 cm is usually permitted . 7. Find limbs and back to determine position of fetus,

Lateral palpation Hands are placed on either side of uterus, support one side of the uterus while the other hand progresses down and palpates the length of the uterus, vise versa. ‘Walk’ both hands across the uterus from side to side, from the fundus to the symphysis pubis

8. Engagement > presentation of the fetus

Pawlik’s Manoeuvre: using one hand with fingers facing the women’s head, the presenting pole is held between the fingers and thumb, done gently when head is three-fifths of the head has passed through the pelvic brim the presentation is ‘Engaged’. Non- engaged presentation can be considered as ‘free

Pelvic Palpation: Using both hands, one of either side of the presentation, press in gently. The presentation can be felt beneath the hands, Helpful if a woman takes a deep breath and hold it for a moment while the hands are able to feel deeply around the presentation

9. Auscultation of the fetal heart Pinard stethoscope or Doppler (Sonicaid) is an electronic device for fetal heart monitoring -

Perform abdominal palpation to determine fetal position Lubricate Doppler Place on fetal shoulder ( scapula) Palpate maternal pulse to ensure they are different and you are listening to two different rates...