Examination and Measurement of the Abdomen
Shape (ovoid, circular, sagging, pointed) of the abdomen, presence of post-surgical scars, abdominal circumference, fundal height.
During physiological course of gestation, the abdomen has an ovoid shape. Changes in the shape of the abdomen may be indicative of polyhydramnios (spherical) or narrow pelvis (sagging - in multiparas, pointed - in primaras) (Fig. 7.1). In case of excessive extension or separation of the muscles of the anterior abdominal wall (usually in multipa-ras) abdomen can also be sagging.
Abdomen in case of polyhydramnios has a spherical shape, increases very fast, inadequately to the gestational age, it is larger than the normal value for the expected age of gestation; if the fetus is positioned transversely, the abdomen acquires the form of a transverse oval.
During examination of the anterior abdominal wall one should note postoperative scars and their localization (Fig. 7.2). Special attention should be paid to palpation of the abdomen in the region of the scar after cesarean section. Thus, sharp pain at palpation may indicate the failure of the uterine scar that requires urgent cesarean section.
Abdominal circumference is measured at the level of the umbilicus (Fig. 7.3). To measure the fundal height (FH) the beginning of the measuring tape shall be fixed with one hand on the level of the upper edge of the pubic, with the other hand the tape shall be drawn along the white line of the abdomen down to the bottom of the uterus (Fig. 7.4). This index is used to determine the gestational age. Thus, at a gestational age of 12 weeks the FH is at the level of the upper edge of the pubic, at 16 weeks - 6 cm above the pubic, 20 weeks - 12 cm, 24 weeks - 18-20 cm, 28 weeks - 24-26 cm, 32 weeks - 28-30 cm, 36 weeks - 34-36 cm, 40 weeks - 34-35 cm (Fig. 7.5).