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   

 

Figure 2.2   

 

  • 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   

 

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