Upload
shams
View
352
Download
0
Embed Size (px)
Citation preview
ABDOMINAL ASSESSMENT
• Abdomen assmt provide information about uterine growth and confirm EDD/EDB
• 12 weeks – uterus above symphysis pubis,• 16 week – between symphysis pubis and
umbilicus• 20 weeks – at umbilicus• 36 weeks – at xiphoid process• 40 weeks – fetal head x pelvic cavity called
lightening.Therefore uterus sinks
Mac Donald Method
1. Women Lies on her back (trunk elevated) with knee flexed
2. Top of fundus palpated and tape stretched from top of symphysis pubis over abdominal curve to the top of fundus.
From 22 weeks to term fundal height roughly equals + or – 2 cm to the gestational age of foetus in weeks.
Second & Third trimester
• McDonald’s rule :
Height of fundus (in Cm) x 8/7 =Duration of pregnancy in weeks
Eg: If fundal height = 22cm X 8/7 =
25weeks
Leopold’s ManeuvarStand beside the women, facing her head with dominant
hand near her First Maneuver
A) Palpate uterine fundus
Distinguish betweenCeaphalic and breech(buttocks) presentation– breach is softer andirregular in shape thanhead.The head is harder,round and uniformshape.
Second Maneuver
A) Hold left hand steady on one side of the uterus while palpating the opposite side of the uterus with the right hand.
B) Hold the right hand
steady while palpating opposite side of uterus with left hand.
To determine which
side is the fetal back
on and which side the
arms and legs (small
parts) are on.
Fetal back is smooth,
convex surface. Fetal
arms and legs feel
nodular.
Third ManeuverA) Palpate the
suprapubic area
B) Grasp the presenting part gently between thumb and finger
To confirm the presentationfelt in the first maneuverand to determine ifpresenting part is engaged.
If a breach was palpated inthe fundus, expect a hardround head in this area.If the presenting part is notengaged, grasping with thefinger moves it upwards inthe uterus.
Fourth Maneuver
Done only if the fetus is
In ceaphalic presentation
A)Turn so as to face the
womans feet, place
hands on each side of
the uterus with
fingers pointed towards
pelvic inlet
To determine whether
head is flexed (vertex) or
extended (face)
B) Slide hands downward
on each side of the
uterus, on one side the
fingers should slide to
upper edge of symphysis,
On other side, your fingers
meet an obstruction, the
cephalic prominence
If head is flexed,ceaphalic prominence(forehead) is felt onopposite side from fetalback, if head isextended, the ceaphalicprominence (occiput) isfelt on the same side asthe fetal back.
Auscultating fetal heart rate
• Purpose – To evaluate fetal condition and tolerance of labour
1.Explain
2.Wash hands (using warm water)
3.Use leopold’s maneuver – Identify back ---it is close to maternal abdomen, were fetal heart sound is clear
Equipments to assess FHR
• Fetoscope
• Doppler transducer (place H2o soluble gel over transducer to make interface for clear signal transmission. Place transducer over fetal back and move it till you hear FHS