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Antenatal Palpation.

Carole Baker



Rationale for Antenatal

Palpation• Assess fetal growth, size and wellbeing.

• Locate fetal position and presentation.

• Detect deviations from the norm.



Indications for Antenatal

Palpation.• 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

Palpation• Inspection.

• Palpation.

• Auscultation.



Inspection

Size May Be Affected By:

• Gestational period.

• Multiple pregnancy.

• Fetal size.

• Fetal lie

• Obesity

• Lax uterine muscles• Polyhydramnious

• Oligohydramnious

• Uterine fibroids



Shape.• 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 andpresentation 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 thelie.



Pelvic Palpation

• Pelvic presentation assesses the

presentation, i.e. the part of the fetuslying 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.• Engagement into the pelvis is assessed

according to the passage of the widesttransverse diameter through the pelvicbrim.

• In a cephalic presentation this is thebiparietal diameter (9.5cms).

• In a primigravida this usually occurs after 36 weeks.



Engagement.• This is generally

measured in fifths.• The measurement

recorded is the

amount that is not inthe pelvic brim.



Auscultation.• Every examination or after every

investigation.• 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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