From the Guidelines
A pregnant female's abdomen on physical examination is characterized by progressive enlargement corresponding to gestational age, with notable changes in uterine size, shape, and fetal palpability. The physical examination of a pregnant female's abdomen should assess for signs of complications, such as hepatic tenderness suggesting hepatic swelling and risk of rupture, as well as signs of impending eclampsia, including brisk reflexes and papilledema 1. In a normal pregnancy, the abdomen becomes noticeably rounded with the umbilicus gradually flattening and potentially everting in later stages. Key features to note during the physical examination include:
- Progressive uterine enlargement, with the fundus rising approximately 1 cm per week after 12 weeks
- Appearance of linea nigra, a dark vertical line from the pubic symphysis to the umbilicus
- Development of striae gravidarum, or stretch marks
- A firm, smooth uterus that becomes more prominent as pregnancy advances
- Palpable fetal parts and detectable fetal movements after 20 weeks
- Fetal heart sounds audible via Doppler device after approximately 10-12 weeks. These findings are crucial in assessing fetal growth, position, and overall pregnancy progression, while also identifying potential complications, as outlined in the European Heart Journal's position paper on peripartum management of hypertension 1.
From the Research
Physical Examination of a Pregnant Female's Abdomen
- The abdomen of a pregnant female is typically examined to monitor the growth and well-being of the baby 2
- During the examination, the midwife may use manual palpation to assess the size and position of the fetus, as well as to check for any abnormalities 2
- The abdominal examination is considered an essential part of midwifery consultations and can help support a woman's bodily sensation of her baby 2
- The examination may also involve assessing the uterus for tenderness, rigidity, or other signs of complications such as placental abruption 3, 4
Signs of Complications
- Placental abruption, a condition where the placenta separates from the uterus, can cause abdominal pain, vaginal bleeding, and uterine contractions 3, 4
- The clinical manifestations of placental abruption can vary, but may include a tender and rigid abdomen, as well as abnormalities in the fetal heart rate tracing 3, 4
- Other complications, such as preeclampsia, can also affect the abdomen and may cause symptoms such as abdominal pain and tenderness 5
Importance of Abdominal Examination
- The abdominal examination is crucial for monitoring the health and well-being of both the mother and the fetus 2
- Regular examinations can help identify potential complications early on, allowing for prompt treatment and management 2, 3, 4
- The examination can also provide an opportunity for the midwife to educate the woman about her pregnancy and answer any questions or concerns she may have 2