Pregnant women should not be offered routine screening for hepatitis C virus because there is insufficient evidence to support its clinical and cost effectiveness. Pregnant women should not be offered routine antenatal screening for group B streptococcus because evidence of its clinical and cost effectiveness remains uncertain.
Routine antenatal serological screening for toxoplasmosis should not be offered because the risks of screening may outweigh the potential benefits. Although there is a great deal of material published on alternative screening methods for pre-eclampsia, none of these has satisfactory sensitivity and specificity, and therefore they are not recommended.
The evidence does not support the routine use of antenatal electronic fetal heart rate monitoring cardiotocography for fetal assessment in women with an uncomplicated pregnancy and therefore it should not be offered.
Was this page helpful? Yes No. View all pregnancy and birth services. Related information. Content disclaimer Content on this website is provided for information purposes only. Reviewed on: Palpation Ask the patient to comment on any tenderness and observe her facial and verbal responses throughout.
Fundal Height Use the medial edge of the left hand to press down at the xiphisternum, working downwards to locate the fundus. Measure from here to the pubic symphysis in both cm and inches. Turn the measuring tape so that the numbers face the abdomen to avoid bias in your measurements.
Uterus should be palpable after 12 weeks, near the umbilicus at 20 weeks and near the xiphisternum at 36 weeks these measurements are often slightly different if the woman is tall or short.
By TeachMeSeries Ltd Fetal Auscultation Locate the back of the fetus to listen for the fetal heart, aim to put your instrument between the fetal scapulae to aim toward the heart. Completing the Examination Palpate the ankles for oedema and test for hyperreflexia pre-eclampsia Thank the patient and allow them to dress in private Wash your hands Summarise findings Perform: Blood pressure Urine dipstick.
Hands - palpate the radial pulse. Found an error? Is our article missing some key information? Make the changes yourself here! Don't ask me again. This website uses cookies. Palpation of the abdomen The liver, spleen, and kidneys must be specifically palpated. Any other abdominal mass should be noted. The presence of an enlarged organ, or a mass, should be reported to the responsible doctor, and the patient should then be assessed by the doctor.
Examination of the uterus and the fetus D. Palpation of the uterus Check whether the uterus is lying in the midline of the abdomen. Sometimes it is rotated either to the right or the left. Feel the wall of the uterus for irregularities. An irregular uterine wall suggests either: The presence of myomas fibroids which usually enlarge during pregnancy and may become painful.
A congenital abnormality such as a bicornuate uterus. Determining the size of the uterus before 18 weeks gestation Anatomical landmarks, i. Gently palpate the abdomen with the left hand to determine the height of the fundus of the uterus: If the fundus is palpable just above the symphysis pubis, the gestational age is probably 12 weeks.
If the fundus reaches halfway between the symphysis and the umbilicus, the gestational age is probably 16 weeks. Figure 1B Determining the uterine size before 24 weeks F.
Determining the height of the fundus from 18 weeks gestation The symphysis-fundus height should be measured as follows: Feel for the fundus of the uterus. This is done by starting to gently palpate from the lower end of the sternum. Continue to palpate down the abdomen until the fundus is reached. When the highest part of the fundus has been identified, mark the skin at this point with a pen. If the uterus is rotated away from the midline, the highest point of the uterus will not be in the midline but will be to the left or right of the midline.
Therefore, also palpate away from the midline to make sure that you mark the highest point at which the fundus can be palpated.
Do not move the fundus into the midline before marking the highest point. Measure the symphysis-fundus SF height. Having marked the fundal height, hold the end of the tape measure at the top of the symphysis pubis. Lay the tape measure over the curve of the uterus to the point marking the top of the uterus.
The tape measure must not be stretched while doing the measurement. Measure this distance in centimetres from the symphysis pubis to the top of the fundus. This is the symphysis-fundus height. If the uterus does not lie in the midline but, for example, lies to the right, then the distance to the highest point of the uterus must still be measured without moving the uterus into the midline. Palpation of the fetus The lie and presenting part of the fetus only becomes important when the gestational age reaches 34 weeks.
The following must be determined: The lie of the fetus. This is the relationship of the long axis of the fetus to that of the mother. The lie may be longitudinal, transverse, or oblique. The presentation of the fetus. This is determined by the presenting part: If there is a breech, it is a breech presentation.
If there is a head, it is a cephalic presentation. If no presenting part can be felt, it is a transverse or oblique lie. The position of the back of the fetus. This refers to whether the back of the fetus is on the left or right side of the uterus, and will assist in determining the position of the presenting part. Methods of palpation There are four specific steps for palpating the fetus.
Figure 1B The four steps in palpating the fetus First step. Having established the height of the fundus, the fundus itself is gently palpated with the fingers of both hands, in order to discover which pole of the fetus breech or head is present.
The head feels hard and round, and is easily movable and ballotable. The breech feels soft, triangular and continuous with the body. Second step. The hands are now placed on the sides of the abdomen.
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