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Antenatal Palpation Fetal Heart Sounds

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Antenatal Palpation Fetal Heart Sounds

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									Antenatal Palpation.
     Carole Baker
      Rationale for Antenatal
• Assess fetal growth, size and wellbeing.
• Locate fetal position and presentation.
• Detect deviations from the norm.
      Indications for Antenatal
• Each antenatal assessment.
• On admission to hospital for any reason.
• Prior to invasive screening tests
  i.e. Amniocentesis, induction of labour.
• Prior to auscultation of the fetal heart and the
  use of CTG equipment.
 Technique Used for Antenatal
• Inspection.

• Palpation.

• Auscultation.
         Size May Be Affected By:

•   Obesity               •   Gestational period.
•   Lax uterine muscles   •   Multiple pregnancy.
•   Polyhydramnious       •   Fetal size.
•   Oligohydramnious      •   Fetal lie
•   Uterine fibroids
• May give an indication to the fetal
  position or presentation.

A dip at the umbilicus may be indicative of
 an occipito-posterior presentation.
            Skin Changes

• Linea nigra.
• Striae gravidarum
• Signs of previous abdominal surgery.
Fetal Movements
           Fundal Palpation
• Assess the estimated period of gestation
  by assessing fundal height.

• Suggest the indication of lie and
  presentation of the fetus, according to the
  presence of the fetal pole (head, buttocks).
          Lateral Palpation.

• Assess the main body of the uterus to
  identify the fetal position and confirm the
          Pelvic Palpation

• Pelvic presentation assesses the
  presentation, i.e. the part of the fetus
  lying in the lower segment of the uterus
  or at the pelvic brim.
   Pelvic Palpation Continued.
It can then determine:
• Whether the fetus is flexed.
• Whether the presenting part has engaged
   in the pelvis.
• How ‘mobile’ or ‘movable’ the presenting
   part is if it has not engaged.
• Engagement into the pelvis is assessed
  according to the passage of the widest
  transverse diameter through the pelvic
• In a cephalic presentation this is the
   biparietal diameter (9.5cms).
• In a primigravida this usually occurs after
  36 weeks.
• This is generally
  measured in fifths.
• The measurement
  recorded is the
  amount that is not in
  the pelvic brim.
• Every examination or after every
• The fetal heart sounds are heard through
  the fetal shoulder.
• Assess it’s presence
• Rate 110-160.
• Regularity
• Veriability
         Records. (UKCC,1998)
•   Fundal height
•   Lie
•   Presentation and degree of engagement.
•   Position.
•   Fetal heart rate and the equipment used.
•   Fetal movements felt.
•   Any additional info. i.e. Contractions, scars,
    liquor volume, (Date Sign & print name)

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