On this Learning Station, you can read and test your knowledge. Tap on a book to open its chapter list. In each chapter, you can take a quiz to test your knowledge.
To take tests, you must register with your email address or cell number. It is free to register and to take tests.
For help email email@example.com or call +27 76 657 0353.
Learning is easiest with printed books. To order printed books, email firstname.lastname@example.org or call +27 76 657 0353.
Visit bettercare.co.za for information.
When you have completed this skills chapter you should be able to:
The abdominal examination forms an important part of every complete physical examination in labour. The examination is done:
It is helpful to look at the shape and contour of the abdomen.
It is important to ask yourself whether the height of the fundus is in keeping with the patient’s dates and the findings at previous antenatal attendances.
It is important on palpation to assess the size of the fetus. This is best done by feeling the size of the fetal head. Is the size of the fetus in keeping with the patient’s dates and the size of the uterus? A fetus which feels smaller than expected is likely to be associated with:
The lie and presentation of the fetus is decided on abdominal palpation by using the four steps described for antenatal care.
It is important to know whether the lie is longitudinal (cephalic or breech presentation), oblique, or transverse. With an abnormal lie, there is an increased risk of umbilical cord prolapse. An abnormal lie may suggest that there is a multiple pregnancy or a placenta praevia.
It is also important to know the presentation of the fetus. If a breech presentation is present, it must be decided whether a vaginal delivery is possible. With breech presentation, there is an increased risk of cord prolapse or a placenta praevia.
If the presentation is cephalic, it is sometimes possible when palpating the abdomen to determine the presenting part of the fetal head (vertex, face or brow). Figure 8A-1 indicates some features that can assist you in determining the presentation.
Figure 8A-1: Vertex, face and brow presentations
This assessment is an essential part of every examination of a patient in labour. The descent and engagement of the head is an important part of assessing the progress of labour and must be assessed before each vaginal examination.
The amount of descent and engagement of the head is assessed by feeling how many fifths of the head are palpable above the brim of the pelvis:
It is very important to be able to distinguish between 3/5 and 2/5 head palpable above the pelvic brim. If only 2/5 of the head is palpable, then engagement has taken place and the possibility of disproportion at the pelvic inlet can be ruled out.
Descent and engagement of the head are assessed on abdominal and not on vaginal examination.
Figure 8A-2: An accurate method of determining the amount of head palpable above the brim of the pelvis
A uterus may be regarded as abnormally hard:
This may occur:
When there is both hardness and tenderness of the uterus, without period of relaxation during which the uterus is not tender, the commonest causes are:
Therefore, there is likely to be a serious problem if the uterus is harder than normal and there is also tenderness without periods of relaxation. Hardness or tenderness of the uterus must be recorded on the partogram and reported immediately to the responsible doctor.
Contractions can be felt by placing a hand on the abdomen and feeling when the uterus becomes hard, and when it relaxes. It is therefore possible to assess the length of a contraction by taking the time at the beginning and end of the contraction. The strength of contractions is assessed by measuring their duration, and also the frequency with which they occur in a period of 10 minutes.
Figure 8A-3: Method of grading the duration of uterine contractions for recording on the partogram
The frequency of contractions is assessed by counting the number of contractions that occur in a period of 10 minutes
The fetal heart rate must be detected and the fetal heart rate pattern assessed and recorded every time the abdomen is examined in labour.