Nursing Component Task
Nursing procedures & clinical learning

Midwifery (RM)

Abdominal Examination of a Pregnant Woman/Client

Abdominal examination assesses uterine size, fetal lie, presentation, position, engagement, growth, tenderness, contractions, and fetal heart according to gestation and local practice. It is a respectful, systematic assessment that supports labour and antenatal decisions.

Purpose

  • Assess fetal growth, lie, presentation, position, and engagement
  • Assess uterine tenderness and contractions
  • Locate and assess fetal heart and identify findings requiring referral

Indications

  • Routine antenatal assessment from the appropriate gestation
  • Assessment of labour progress or abdominal symptoms
  • Concern about growth, presentation, fetal movements, or fetal wellbeing

Equipment

  • Private examination couch and drapes
  • Hand-hygiene supplies
  • Measuring tape
  • Fetoscope or Doppler and gel
  • Clock or timer
  • Antenatal record and documentation materials

Preparation

  • Check gestation, previous findings, bladder status, and available equipment.
  • Warm hands and explain each step before touching the abdomen.

Procedure steps

  • Explain the examination, obtain consent, provide privacy, and ask the woman to empty her bladder if appropriate.
  • Position semi-recumbent with support and avoid prolonged flat supine positioning.
  • Inspect the abdomen for size, shape, scars, movements, skin changes, and visible contractions.
  • Measure symphysis-fundal height using the correct landmarks and compare with gestation and previous measurements.
  • Palpate gently for uterine tone, tenderness, contractions, lie, presenting part, position, and engagement using the accepted abdominal palpation sequence.
  • Locate and count fetal heart for the required period, comparing with maternal pulse when necessary.
  • Assess fetal movement and ask about pain, bleeding, fluid loss, and other symptoms.
  • Explain findings, identify abnormal presentation, growth, tenderness, or fetal rate, and arrange review.
  • Help the woman dress and remain comfortable.
  • Document gestation, measurement, palpation findings, fetal heart, symptoms, education, and referral.

Precautions

  • Use gentle palpation and stop for pain, distress, bleeding, or suspected placental complication.
  • Do not use Doppler or fetoscope findings to falsely reassure when the woman is clinically unwell.
  • Differentiate fetal heart from maternal pulse.
  • Escalate abnormal fetal rate, absent fetal heart, severe tenderness, or growth discrepancy.

Aftercare

  • Provide privacy, explain results, and arrange follow-up or referral.
  • Give instructions about fetal movement and urgent danger signs.

Nursing considerations

  • Interpret measurements with gestation, maternal size, fetal number, and trends.
  • Use respectful touch and maintain dignity throughout.

Patient education

  • Explain the findings in plain language and reinforce fetal movement and danger-sign advice.
  • Tell the woman to seek urgent care for reduced movement, bleeding, fluid loss, or severe pain.

Documentation

  • Record fundal height, lie, presentation, position, engagement, contractions, fetal heart, maternal symptoms, and plan.
  • Document the device and time where required.

References and further reading

Educational resource only. Follow current Nursing and Midwifery Council guidance, local institutional protocols, scope of practice, and clinical supervision.

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