Nursing & Health Survival Guide

Alison Edwards

• Publisher: Routledge
• Year: 2014
• eBook ISBN: 9781317905745
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

A pocket-sized reference tool for quick access to crucial information in any community or antenatal setting.

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Abdominal examination

• Ensure woman’s bladder is empty
• Make sure the woman is comfortable
• Get consent

Inspection

• Examine the abdomen for the following: shape, size, scarring, rashes, striae gravidarum (stretch marks), a saucer-shaped dip at the umbilicus (suggests an occipito posterior [OP] position), bruising or trauma (? domestic violence), surgical scars.

Palpation

• Fundal palpation – begin at the fundus (top) of the uterus with both hands to identify which pole (head or bottom) of the fetus is situated there. NB If a woman is expecting twins then two poles are likely to be felt here.

Tip As a general rule, a head is harder and rounder than a bottom and is ballotable (can be rocked from side to side).

Figure 1 Fundal palpation

• Lateral palpation – with one hand support the abdomen and use it to gently push the fetus towards the other side. With the other hand (not your fingertips as this is uncomfortable) palpate from top to bottom to feel for either a firm back or limbs.
• Swap over to palpate down the other side of the uterus to confirm your findings.

Figure 2 Lateral palpation

• Pelvic palpation
• Method 1 – using both hands as shown in Figure 3. This will enable you to confirm the fetal presentation in addition to confirming the level of engagement.
• Method 2 – the Pawlic’s grip, as illustrated in Figure 4, but this is much more uncomfortable for the woman.

Figure 3 Two-handed palpation

Figure 4 Pawlic’s grip

Auscultation

• Ask about pattern of fetal movements – refer if pattern has changed.
• Current NICE guidance (Antenatal Care 2003, 2008a) does not recommend listening to the fetal heart at routine antenatal visits. However, it can be reassuring for parents to hear their baby.
• Using a Pinard’s stethoscope count the fetal heart rate for a full minute.
• Check the maternal pulse at the same time to ensure that it is the fetal heart you are hearing.
• Following this, a Doppler device can be used.

Tip Remember not to lay the woman completely flat. The weight of the uterus can put pressure on the maternal vena cava, reducing maternal and fetal blood supply and causing supine hypotensive syndrome. As you get more practiced there is no need to have the woman semi-recumbent; she could be sitting or even standing – whichever is most comfortable for her.

Tip The fetal heart is best heard over the anterior shoulder of the fetus.

Measurement

• Measure symphysis–fundal height.
• Use the tape measure with the centimetres on the underside to reduce bias.
• Secure the tape measure at the fundus with one hand.
• Measure down the longitudinal axis of the uterus to the symphysis pubis.
• Plot the result on the customised growth chart.

Expected Findings

Presentation – cephalic (head), breech (bottom). (Shoulder and cord presentations are possible but unlikely to be detected by palpation alone.)

Lie – longitudinal, oblique or transverse.

Figure 5 Longitudinal lie

Figure 6 Oblique lie

Figure 7 Transverse lie

Engagement – the number of fifths of the fetal head palpated above brim of pelvis. Engagement has occurred when only two to three fifths of the fetal head can be felt.

Figure 8 Engagement

Source: Reproduced from ‘ABC of labour care: Labour in special circumstances’, by Geoffrey Chamberlain and Philip Steer, BMJ (1999) 318: 1124–1127 © 1999 with permission from BMJ Publishing Group Ltd

Position – the direction the occiput of the fetal skull faces, e.g. right occipital anterior (ROA), left occipital arterior (LOA), left occipital posterior (LOP), right occiptal posterior (ROP).

Figure 9 Fetal position

Source: From http://www.brooksidepress.org. Used with permission

Amniotic fluid index

Figure 10 Amniotic fluid index i...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Contents
• Dedication
• Abdominal examination
• Amniotic fluid index
• Anaemia
• Anatomy
• Antenatal appointments
• Antenatal screening
• Benefits
• Bishop's score for induction of labour
• Blood pressure taking
• Blood values
• BMI
• Booking advice
• British Sign Language
• Calculating Estimated Due Dates
• Cholestasis
• CMACE Top Ten recommendations
• CTG interpretation
• Customised growth charts
• Diabetes
• Drug administration
• Emergencies
• Female circumcision
• Functions of the placenta
• Methods of induction
• Minor disorders
• Substance misuse
• Support groups
• Useful websites
• Venepuncture
• Vulnerable groups of women
• General abbreviations
• References
• Backmatter