Pregnant Abdomen Examination

Examination of the pregnant abdomen is performed routinely throughout pregnancy.  Expectant mothers attend ante-natal check-ups regularly throughout their pregnancy where this is performed by both doctors and midwives.  You will get the chance to practice this skill during your obstetrics and gynaecology placement in medical school, however as you will likely encounter pregnant women in whatever area you specialise in (ok there are a few exceptions) it is an essential skill to be able to perform, as such it IS commonly examined on in OSCEs.

This skill demonstrates two areas; your communication skills with the mother, and your examination technique.  There will usually be real patient volunteers for this station so remember to be gentle as your patient may have had her bump examined many times before your turn.  Like most stations this still follows the general rule of “inspection, palpation, auscultation”.

Subject steps

  1. Introduce yourself and clarify the patient’s identity. Wash your hands.  Explain what you would like to do and gain her consent.

    For this station the patient should be lying on the bed, as flat as possible but in reality whatever is most comfortable for her.  She should ideally be exposed from the pubic bone to below her breasts.

  2. Try and put mum at ease. A few simple but friendly questions to help her gain your trust includes:

    • “how are you feeling?”
    • “do you know what you are having?”
    • “is this your first pregnancy?”

    This shows the examiner that you can be caring, rather than jumping in hands first.  As you become more skilled at this station you can incorporate these types of questions into your examination technique along the way.

  3. Perform a general inspection of mum and her bump. Comment if she looks comfortable, does she have any abdominal striations or Linea Nigra, and whether she has previous operative scars e.g. previous caesarean section.

    If greater than 24 weeks you can expect some foetal movements, comment if so. This shows you really are observing her closely.

  4. Cover mum up and thank her at this stage. Wash your hands.

  5. Inform your examiner that for completeness you would like to check her blood pressure, and also perform urinalysis. If you have any concerns regarding the baby’s heart rate you should suggest that a CTG should also be performed. You will not usually be asked to perform these extra skills as part of this station.

  6. An extension to this station could be discussions regarding glucosuria or proteinuria, and/or elevated blood pressure. You should therefore be familiar with conditions such as gestational diabetes and pre-eclampsia.