Remote Primary Health Care Manuals

Unborn baby’s growth 

   

Do checks that you are skilled to do — midwife/doctor consult for other checks

Positioning pregnant woman

  • In later pregnancy the uterus is heavy. When a woman in the third trimester of pregnancy lies on her back the weight of the uterus presses down on big abdominal blood vessels, she may feel faint
  • Put a wedge/pillow under the right hip to tilt woman slightly to left
  • If woman feels faint — roll onto left side straight away, check blood pressure and heart rate

Measuring fundal height

  • Tells if the baby is growing properly and approximately how many weeks pregnant
  • Measure from fundus (top of uterus) to top edge of pubic bone 
  • Measure in centimetres at every antenatal visit once uterus can be felt — usually after 12–14 weeks pregnant
    • Measure the same way at each visit so measurements are consistent

Do

  • Ask woman to empty bladder — Collect urine sample if needed
  • Position pregnant woman as above
  • If you notice a contraction — stop until it is over
  • Find top of uterus by gently pressing side of your hand where you think it is — Figure 2.1 — move hand up and down until it is against top of uterus (feels like a smooth rounded muscle)

Figure 2.1   

 

Identify top of uterus by gently pressing side of hand on women's abdomen.

Figure 2.2   

 

Fundal height determined by measuring woman's abdomen in the midline from top of uterus to pelvic bone.

  • Measure with disposable paper tape
    • Have tape facing downward so previous readings or expected length of pregnancy doesn't influence result
    • Put zero end of tape measure at top of uterus and hold with 1 hand
    • With other hand, stretch tape from top of uterus down midline to top of pubic bone — Figure 2.2. Stretch tape over any fold of skin/fat
    • Often easier to ask woman to find pubic bone herself
  • Compare your measurement with expected measurement for woman’s dates — Figure 2.3 and/or ultrasound
    • 12 weeks — top of uterus just above pubic bone
    • 20–36 weeks — measurement in centimetres about the same as number of weeks pregnant. At around 20 weeks the fundal height will be around the level of the umbilicus
    • 36–38 weeks — top of uterus at/under sternum
    • 40 weeks (term) — fundal height less than 38 weeks measurement as presenting part (eg head) drops down into pelvis. May not happen with first baby
    • Twins — fundal height will be several weeks ahead of pregnancy dates

Figure 2.3   

 

Expected fundal height by anatomical landmarks.

Medical consult if

  • Fundal height 3cm or more than expected — baby may be larger than gestational age or may be more than one baby
  • Fundal height 3cm or less than expected — baby may be small for gestational age
  • Will need obstetric ultrasound as soon as possible and review at antenatal clinic

Palpation of the pregnant uterus

  • Should only be done if you are trained in this procedure or with midwife/medical consult
  • Helps identify presenting part (part of baby furthest down in pelvis)
  • If a lot of heads or bottoms — suspect twin pregnancy