10 hours ago Abdominal pregnancy is a rare type of ectopic pregnancy where the developing embryo implants and grows within the peritoneal cavity. Abdominal pregnancy can further be classified as being primary or secondary. Primary abdominal pregnancy which is extremely rare occurs when a fertilized ovum implants itself initially on some abdominal organ. >> Go To The Portal
Abdominal pregnancy is a rare type of ectopic pregnancy where the developing embryo implants and grows within the peritoneal cavity. Abdominal pregnancy can further be classified as being primary or secondary. Primary abdominal pregnancy which is extremely rare occurs when a fertilized ovum implants itself initially on some abdominal organ.
Full Answer
Knowing what to say in a pregnant abdominal examination is important. Here are a few recommended phrases: “I have been asked to perform an examination of your tummy (can also say ‘baby bump’) today. Have you had one before? Do you understand what it involves?”
Abdominal pregnancy is a rare type of ectopic pregnancy where the developing embryo implants and grows within the peritoneal cavity. Abdominal pregnancy can further be classified as being primary or secondary. Primary abdominal pregnancy which is extremely rare occurs when a fertilized ovum implants itself initially on some abdominal organ.
Examination of the abdomen in pregnancy Determine the gestational age from the size of the uterus. Measure the symphysis-fundus height. Assess the lie and the presentation of the fetus. Assess the amount of liquor present.
The diagnostic approach of acute abdomen during pregnancy can be tricky owing to the altered clinical presentations brought about by the anatomical and physiological changes of gestation along with the reluctance to use certain radiological investigations for fear of harming the fetus.
Feel for the fundus of the uterus. This is done by starting to gently palpate from the lower end of the sternum. Continue to palpate down the abdomen until the fundus is reached. When the highest part of the fundus has been identified, mark the skin at this point with a pen.
With abdominal assessment, you inspect first, then auscultate, percuss, and palpate. This order is different from the rest of the body systems, for which you inspect, then percuss, palpate, and auscultate.
b. If Abebech is really seven months pregnant, you would expect her abdomen to measure about 28 cm from her pubic bone to the top of the uterus, i.e. approximately one centimetre for each week of pregnancy dated from the LNMP. Remember the measurement may range from 26-30 cm.
Shape of the abdomen. It is helpful to look at the shape and contour of the abdomen. The shape of the uterus will be oval with a singleton pregnancy and a longitudinal lie. The shape of the uterus will be round with a multiple pregnancy or polyhydramnios.
Documentation of a basic, normal abdominal exam should look something along the lines of the following: Abdomen is soft, symmetric, and non-tender without distention. There are no visible lesions or scars. The aorta is midline without bruit or visible pulsation.
Deep palpation of the abdomen is performed by placing the flat of the hand on the abdominal wall and applying firm, steady pressure. It may be helpful to use two-handed palpation (Figure 93.2), particularly in evaluating a mass. Here the upper hand is used to exert pressure, while the lower hand is used to feel.
The visceral fat area considered normal as range 50-100 for male and 40-80 for female. The abdominal circumference less than 102 cm for male and less than 88 cm for female was considered as normal.
For your best health, your waist should be less than 40 inches around for men, and less than 35 inches for women, although it may vary depending on race or ethnicity.
Abdominal girth is the measurement of the distance around the abdomen at a specific point. Measurement is most often made at the level of the belly button (navel).
In pregnancy, the uterus increases in size to accommodate the developing fetus. At approximately 12 weeks gestation the uterus becomes large enough to be palpable just above the pubic symphysis.
Quick Reference. The hanging downwards of the abdomen over the pelvis, usually due to weakness and lack of firmness of the abdominal muscles. From: pendulous abdomen in The Oxford Dictionary of Sports Science & Medicine »
Scaphoid abdomen is the term given to an inward concavity of the anterior abdominal wall. It is used both for the clinical appearance and its radiological equivalent. In children it maybe a sign of congenital diaphragmatic hernia. In both adult and pediatric patients, it raises the possibility of malnutrition.
It is important to inspect the abdomen for pregnant signs such as: 1 Linea nigra: A dark vertical line running along the midline of the abdomen) 2 Striae gravidarum: Stretch marks on the abdomen due to the sudden weight gain of pregnancy 3 Striae albicans: Silvery-white stretch marks indicative of a previous pregnancy, where old stretch marks have since changed colour.
Linea nigra: A dark vertical line running along the midline of the abdomen) Striae gravidarum: Stretch marks on the abdomen due to the sudden weight gain of pregnancy. Striae albicans: Silvery-white stretch marks indicative of a previous pregnancy, where old stretch marks have since changed colour.
Note that it is very important to distinguish between a foetus which is constitutionally small due to familial reasons but is healthy , and one that has intrauterine growth restriction. Constitutionally small foetuses grow consistently without any compromise. In contrast foetuses that are growth restricted have failed to reach their ‘growth potential.’ There are numerous causes of intrauterine growth restriction including underlying maternal illness, multiple pregnancy (one foetus is commonly compromised), chromosomal abnormalities and maternal smoking.
There are a number of causes including a familial cause, obesity and most importantly gestational diabetes. Gestational diabetes is diabetes which develops after the 20th week of pregnancy.
Whilst the patient is positioning themselves on the bad, wash your hands, grab a measuring tape and a Pinard stethoscope.
Also known as obstetric cholestasis, it is the most common liver disease of pregnancy. The aetiology is thought to be multifactorial due to the cholestatic effect of oestrogen. Obstetric cholestasis is characterised by pruritis (severe itching of the skin) in the absence of a rash.
Face. Look in the eyes for conjunctival pallor (anaemia) and jaundice (intrahepatic cholestasis of pregnancy or hepatitis). Check for oedema of the face (a sign of pre-eclampsia). Intrahepatic cholestasis of pregnancy. Also known as obstetric cholestasis, it is the most common liver disease of pregnancy.
The lie and presenting part of the fetus only becomes important when the gestational age reaches 34 weeks.
Feel for the fundus of the uterus. This is done by starting to gently palpate from the lower end of the sternum. Continue to palpate down the abdomen until the fundus is reached. When the highest part of the fundus has been identified, mark the skin at this point with a pen. If the uterus is rotated away from the midline, the highest point of the uterus will not be in the midline but will be to the left or right of the midline. Therefore, also palpate away from the midline to make sure that you mark the highest point at which the fundus can be palpated. Do not move the fundus into the midline before marking the highest point.
When you are palpating the fetus, always try to assess the size of the fetus itself. Does the fetus fill the whole uterus, or does it seem to be smaller than you would expect for the size of the uterus and the duration of pregnancy? A fetus which feels smaller than you would expect for the duration of pregnancy, suggests intra-uterine growth restriction, while a fetus which feels smaller than expected for the size of the uterus, suggests the presence of a multiple pregnancy.
If the fundus is palpable just above the symphysis pubis, the gestational age is probably 12 weeks.
If the fundus is at the same height as the umbilicus, the gestational age is probably 22 weeks (1 finger under the umbilicus = 20 weeks and 1 finger above the umbilicus = 24 weeks).
The presence of myomas (fibroids) which usually enlarge during pregnancy and may become painful.
This means that the uterus feels tight, or has a contraction, while being palpated. Uterine irritability normally only occurs after 36 weeks of pregnancy, i.e. near term. If there is an irritable uterus before this time, it suggests either that there is intra-uterine growth restriction or that the patient may be in, or is likely to go into, preterm labour.
Palpate the nine regions of the abdomen with either a one-handed or two-handed technique. Communicate with the patient as you are doing the exam to ensure that they know what you will be doing ahead of time. Continue to communicate with the patient throughout the exam to get feedback about tenderness. As well, assess the patient for tenderness, rebound tenderness, guarding upon palpation, or masses in the abdomen.
During early pregnancy, typically in the first and second trimesters (e.g., before 28 weeks’ gestation), the patient can be positioned supine with the head of the bed elevated by 15–30°. Later in pregnancy, during the third trimester (e.g., after 28 weeks’ gestation), the patient should be positioned in the left lateral position to avoid inferior vena cava compression. If the patient lies flat on their back, compression from the uterus on the inferior vena cava can cause the patient to feel unwell, become dizzy, and possibly even lose consciousness.
Performing an abdominal exam on a patient who is pregnant presents unique challenges. Patients who are pregnant can still be affected by similar processes as patients who are not pregnant. So, you mustn’t allow the pregnancy to skew your evaluation of the pain. Inspect the patient as you would any other, but pay attention to a few additional considerations for pregnancy.
Palpation of the fundus during the abdominal exam is usually sufficient to assess the uterus. If there are any concerns, consult the obstetrician.
Acute abdominal pain in pregnancy can be due to obstetric as well as non-obstetric etiologies. The physiological changes of pregnancy increase the risk of developing an acute abdomen. As for non-obstetric causes, any gastrointestinal (GI) disorder can occur during pregnancy. About 0.5%–2% of all pregnant women require surgery for non-obstetric acute abdomen.3,4
The term acute abdomen refers to any serious acute intra-abdominal condition accompanied by pain, tenderness, and muscular rigidity, for which emergency surgery should be contemplated .1It is often indicative of a clinical course of abdominal symptoms that can range from minutes to hours to weeks and is commonly used synonymously for a condition that requires immediate surgical intervention.2The wide range of causes and varied spectrum of clinical presentations pose a formidable diagnostic and therapeutic challenge.
The definitive treatment for acute appendicitis is surgery. The decision to operate or not is crucial. The decision to operate depends on the clinical condition of the patient and investigatory findings. Delay in diagnosis is associated with increased risk of perforation, peritonitis, and septicemia, leading to adverse maternal and fetal outcomes such as miscarriage, preterm labor, and intrauterine death. The fetal loss rate has been reported to be in the range of 3%–5% in cases of unruptured appendix without significant effect on maternal mortality. However, in perforated appendicitis, the fetal loss rate increases to 20%–25% and maternal mortality rate escalates to around 4%.23
These include endocrine, metabolic, cardiovascular, GI, renal, musculoskeletal, respiratory, and behavioral changes. GI changes such as delayed gastric emptying, increased intestinal transit time, gastroesophageal reflux, abdominal bloating, nausea, and vomiting can occur in 50%–80% of pregnant females.8–10Constipation occurring in the last trimester is attributed to the mechanical compression of the colon along with increase in water and sodium absorption due to increased aldosterone levels. Lawson et al observed that there was a significant increase in the mean small bowel transit time during each trimester (first trimester, 125±48 minutes; second trimester, 137±58 minutes; third trimester, 75±33 minutes).11
Note:As pregnancy progresses, the bowel gets displaced laterally and upward (eg, athe appendix can move into the right upper quadrant).
Further increase in uterine size occurs due to expansion by distension and mechanical stretching of the muscle fibers by the growing fetus. At 36 weeks, the uterus reaches the costal margin. The uterine blood vessels also undergo significant hypertrophy to adapt to the increasing demands.
The diagnostic approach of AAP can be tricky owing to the anatomical as well as the dynamic physiological changes brought about by gestation and the reluctance to use radiological diagnostic modalities such as X-ray or computed tomography (CT) scan and a low threshold to subject the patient to an emergency surgical procedure. Physical examination of the abdomen itself can be difficult in the pregnant state. Consequently, this has a bearing on clinical presentations, interpretation of physical findings, as well as a shift in the normal range of laboratory parameters. For example, even in the absence of any infection, pregnancy alone can usually produce white blood cell counts ranging from 6,000 to 30,000/μL, thus mimicking an acute infection.5
Early pregnancy: position the patient supine on the couch, with the head end of the bed elevated to 15-30°.
Inspect the patient from the end of the bed whilst at rest, looking for clinical signs suggestive of underlying pathology:
Linea nigra: a dark line running vertically down the middle of the abdomen (a normal finding in pregnancy). Striae gravidarum: reddish or purple lesions that develop due to overstretching of the abdominal skin as the gravid uterus expands (commonly referred to as stretch marks).
Place the dorsal aspect of your hand onto the patient’s to assess temperature:
General appearance: The patient is alert, oriented X 4, in no acute distress.
Proper charting is an essential form of communication among healthcare professionals. Healthcare providers need to be fluent in SOAP notes because it provides concise and complete documentation that should describe what you observed, what data you collected, and what you did. Take full credit for your hard work!
The diagnosis can be as simple as intrauterine pregnancy and gestational age or specific to a disease process. If you are concerned about differentials, these should be listed too.
Obstetric Examination. The obstetric examination is a type of abdominal examination performed in pregnancy. It is unique in the fact that the clinician is simultaneously trying to assess the health of two individuals – the mother and the fetus.
Uterus should be palpable after 12 weeks, near the umbilicus at 20 weeks and near the xiphisternum at 36 weeks (these measurements are often slightly different if the woman is tall or short). The distance should be similar to gestational age in weeks (+/- 2 cm).
Facing the patient’s head, place hands on either side of the top of the uterus and gently apply pressure. Move the hands and palpate down the abdomen. One side will feel fuller and firmer – this is the back. Fetal limbs may be palpable on the opposing side.
If breech presentation is suspected, the fetal head can be often be palpated in the upper uterus. Ballot head by pushing it gently from one side to the other.
Inspection – Evaluation of the external abdomen. Bruising, for example, may indicate trauma. Distention could be a sign of ascites.
The abdominal exam consists of a number of components, the most basic being inspection, auscultation for bowel sounds, percussion, and palpation. The exam must be completed in this order as palpation before auscultation can lead to an inaccurate representation of bowel sounds.
Abnormals on an abdominal exam may include: Tenderness (location) Guarding (location) Rigidity. Rebound (location)
Note that the abdomen is divided into four quadrants, the right upper quadrant, the right lower quadrant, the left upper quadrant, and the left lower quadrant. The epigastric area (central abdomen) may also be used as a reference point in documentation. The more specific you can be about where an abnormality lies, the better.
Documentation is key to continuity of care for your patients, as well as to protecting yourself should questions arise about ...
Abdomen is soft, symmetric, and non-tender without distention. There are no visible lesions or scars. The aorta is midline without bruit or visible pulsation. Umbilicus is midline without herniation. Bowel sounds are present and normoactive in all four quadrants. No masses, hepatomegaly, or splenomegaly are noted.