Examination of pregnant abdomen

• Uterus size:

  • Normally palpable abdominally by 12 weeks just above symphysis pubis
  • 20 weeks - level of the umbilicus
  • 36 weeks - level of xiphisternum
• Examine on left lateral side when >20 weeks

  • Aortocaval compression
  • Gravid uterus occludes the IVC/aorta
  • Reduces venous return - reduced maternal cardiac output - sympathetic compensation
  • Vasovagal syncope can occur
  • Prolonged can cause maternal +/- foetal compromise
• Symphysis fundal height:

  • Estimate of gestational age
  • Measure in cm between the fundus of the uterus and the upper border of the symphysis pubis
  • Corresponds to gestation +/- 2cm
• Large SFH:

  • Consider gestational diabetes
  • Macrosomia
  • Polyhydramnios
  • Multiple pregnancy
• Small SFH:

  • Oligohydramnios
  • Small gestational age
  • Growth restriction e.g. pre-eclampsia
• Poles and lie:

  • A pole = head or bottom
  • Lie = relationship between foetus and long axis of uterus
  • Longitudinal - head and buttocks are palpable at each end
  • Oblique - lying horizontally
  • Transverse = lies directly across the abdomen, pelvis empty
• Presentation:

  • Cephalic = head down
  • Breech = bottom down
• Breech:

  • Frank breech = both hips are flexed and both knees are extended (legs extending up)
  • Complete = both hips and knees are flexed (curled in a ball)
  • Footling = one or both legs are extended below the buttocks
• Engagement:

  • How far into the pelvis the head has moved
  • How much of the head you can feel in the abdomen
  • If you can feel the whole head and mobile- 5/5th palpable - not engaged
  • If only 2/5th palpable - engaged
• The foetal heart rate should be auscultated over the anterior shoulder