Tuesday, March 26, 2019

Abdominal Palpation of Pregnant Women in Midwifery

What is Antenatal Care?
It is the clinical assessment of fetus and mother during pregnancy. Antenatal care traditionally involves a number of routine visits approximately 12-16 for assessment of pregnant women before and during pregnancy period. 

Physical examination of pregnant women
Fig: Physical examination of pregnant women
How Do You Perform an Abdominal Palpation of Pregnant Women?
By maintaining the below processes we can perform abdominal palpation of pregnant women: 

  • Carry out abdominal palpation at every antenatal visit.
  • Prior to palpation, ask the pregnant woman how she feels, if the baby is moving and her last menstrual cycle occurred or the date she felt the baby first moved.
  • Ensure the place for conducting the palpation provides pregnant women privacy.
  • Prior to abdominal palpation ask the women to empty her bladder.
  • Lie the pregnant women r her back with upper of her body supported with cushions. Never lie a pregnant woman in her back as the heavy uterus may compress the main blood vessels returning to the heart and because of fainting (supine hypotension).
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  • Review the abdomen for scars, previous stretch mark and symptoms of overdistention or other signs of multiple pregnancies such as many fetal parts felt, two fetal heads palpated, excessive or reduced amount of amniotic fluid.
  • Estimate gestation as and assess the fetal growth. After 24 weeks of pregnancy, the most effective way to estimate gestation age is to use a tailor’s tape measure.
  • Measure from the upper border of the symphysis pubis to the top of the fundus by using the measuring tape. Record the measurement in cms. If the measurement is different from calculated weeks by more than 3cms or there is no growth or poor growth from the last examination refer for further investigation. 
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  • Gently palpate the abdomen to assess the lie of the fetus (it should be longitudinal). If not, and the pregnancy is 36 weeks or more refer/seek advice from the next higher level of service.
  • Using to hand, palpate the abdomen and pelvic area to identify the presenting part.
  • After 37 weeks, especially in a prim gravida assess if the fetal head is engaged. If not, ask the pregnant women to sit/stand up and see if the head can be made to fit into the pelvis, refer to the first referral unit or hospital. 
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  • Have to identify where the fetal back is and listen to the fetal heart. If the fetal stethoscope is not available, listen to the fetal heart directly one ear and ask the pregnant women is the baby is moving. If no fetal heart sound is heard or there were poor or reduced fetal movements in the last month of pregnancy refer to the first referral unit or hospital.
  • Discuss all the things with pregnant women with her husband or accompanying family members.
  • Record all findings accurately. Review all findings and if any deviations are found refer to the first referral unit or hospital for more specialized investigations as appropriate. 
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More questions related to this article:

  1. What do you understand by antenatal care?
  2. What does abdominal palpation mean?
  3. What does palpation mean in pregnancy?
  4. How early can you palpate a pregnancy?
  5. How does a pregnant belly feel in early pregnancy?
  6. What does palpable mass mean in pregnancy? 
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