Palpation

The midwife should wash her hands with soap and warm water. Cold hands may irritate the uterus causing it to contract making palpation difficult. The woman should be lying in a semi recumbent position with hands and arms relaxed by her side. Her abdomen should be exposed to reveal an area from the xiphisternum to the pubic area, whilst maintaining dignity.

Women in advanced pregnancy are subject to supine hypotension due to compression of the inferior vena cava by the fetus and growing uterus. Care should be taken to ensure if women feel faint that they are turned into a left lateral position. Palpation should be systematic commencing with fundal height and proceeding to fundal, lateral and pelvic palpation. To assess the height of the fundus (upper border of the uterus) the midwife should place her hand at the xiphisternum and move it downwards over the abdomen until the curved border of the fundus is found.

To measure the symphysis fundal distance the midwife should place a tape measure at the highest point of the fundus and measure downwards to the upper border of the symphysis pubis (not the pubic hair line). The tape measure should be turned so that the inches side is visible to prevent subjectivity and making the tape measure fit the known weeks of gestation. Once the distance has been measured the tape measure should then be flipped over to reveal the measurement in centimetres. The uterus should measure 1cm per week of gestation between 24 and 37 weeks gestation. A uterus measuring 2cm less than confirmed weeks of gestation is said to be small for gestational age, A uterus measuring more than 2cm for the confirmed weeks of gestation is said to be large for gestational age. In both cases further assessment via USS will be necessary. Growth should be plotted on a symphysis-fundal height chart.