Inspection
Procedure
- Inquire whether the bladder is empty. A full bladder makes the examination less reliable and uncomfortable for the woman.
- Pay attention to the skin. This can exhibit old (shiny white) and fresh (purple) striae. Sometimes spider naevi are observed. During pregnancy, these findings are physiological. Oedema of the abdominal skin is sometimes easier to see than to feel.
- Note the shape and curvature of the abdomen:
- Primigravida: Ovoid.
- Multigravida: Rounder, filling sides. If the transverse measurement of the abdomen is greater than the longitudinal measurement, then a transverse presentation is indicated. If the uterus is too large and convex, then this may indicate a pregnancy large for gestational age.
Palpation
The examination is performed while standing to the right of the supine woman. Make sure your hands are warm to avoid unnecessary stimulation of the abdominal muscles and always palpate with the flat of the hand.
Procedure
- Using both hands, palpate the periphery of the uterus and feel the tension in the uterine wall. Non-painful pregnancy contractions (Braxton Hicks) give rise to a transient increase in muscle tension and are physiological.
- Note any irregularities in the uterine surface or swellings adjacent to the uterus.
- If palpating the uterus proves too difficult, then efforts can be made to determine the size of the uterus by means of percussion. The percussion sound over the area of the uterus is muffled or dull.