Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate

Introduction Abdominal palpation and auscultation of the fetal heart rate is recommended as part of routine examination in pregnancy to assist in assessing fetal wellbeing.

Requirements  Sonicaid to identify the fetal heart rate.  Aqueous gel  Tape measure

Recommendations for Abdominal Palpation Palpation is not performed during a contraction

Only perform a GENTLE abdominal palpation for any woman with:  History of ante partum hemorrhage  Premature labour  Severe (acute) abdominal pain

 Documentation of fundal height is advised from 24/40  A clinical estimate followed by a symphyso-fundal height using a tape measure should also be used  A consistent approach to measurement increases accuracy  Palpate the fundus first to identify the upper limit . Measure from the top of the fundus to the top of the pubic symphysis . The tape measure should stay in contact with the skin. . It is not recommended to repeat the measurement.

 If the fundal height is more than 2cm below or above expected height, an obstetric opinion advised. Refer Antenatal Clinic 9784 2626 or if unavailable contact the obstetric registrar via switchboard 9784 7777

 Fundal height measurement is of little value in a twin pregnancy.

Recommendations for Intermittent Auscultation of fetal Heart Rate  Is recommended from 20 weeks gestation  It is important to identify maternal pulse before locating the fetal heart.  Using intermittent auscultation the normal heart rate range is >110bpm and < 160bpm

If fetal heart rate or fetal movements are not present after 24 weeks gestation immediately, contact the Women’s Health Unit on 9784 7959

SMCP GPLU 2018 Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate

 Leopold’s manoeuvres:[1] a) Fundal palpation- to locate the upper pole of the fetus and note if cephalic or breech b) Lateral palpation- to locate the fetal back, anterior shoulder and limbs c) Pawlick’s grip- to assess the presentation and station. This can be tender and some warning is appropriate. More relevant from 36/40 onwards. d) Deep pelvic palpation (not performed if presenting part high and mobile or if known placenta praevia) - to assess the degree of mobility and flexion of the presenting part and the amount of presenting part above the brim of the pelvis. The clinician is facing the women’s feet with the flats of the hands used to press into the suprapubic area. Again, this can be tender and may not be relevant before 36/40 [2].

References Peninsula Health Clinical Practice Guidelines, Abdominal Examination/P Palpation Obstetrics and Gynecology, Department of Women’s health, pp 1-4, March 2018 Peninsula Health Clinical Practice Guidelines, Fetal Surveillance, Department of Women’s Health, pp 1-5, May 2017 [1] Christian Gerhard Leopold (1894) Die Leitung der regelmäßigen Geburt nur durch äußere Untersuchung. Arch Gynäkol 45: 337–368

SMCP GPLU 2018 Shared Maternity Care Program Guidelines Abdominal Palpation/Auscultation of Fetal Heart Rate

[2] NICE. (2017) Antenatal care for uncomplicated pregnancies. CG 62

SMCP GPLU 2018