Four-step palpation method

The four-step palpation method is a method of determining the size of the fetus and the amount of amniotic fluid by palpation to determine whether the fetus, the fetal exposure, the fetal orientation, the fetal first exposure, the uterus size is consistent with the gestational age. After the pregnant woman urinates before the examination, lying on the examination bed, exposing the abdomen, the legs are slightly flexed and abducted, and the abdominal muscles are relaxed. Basic Information Specialist classification: maternity check check classification: physical examination Applicable gender: whether women are fasting: not fasting Tips: Relax your body and actively cooperate with your doctor. Normal value The normal fetal form means that the baby's spine is in the direction of the mother's spine. The normal fetal head is first exposed to the head and the first to enter the pelvis. The normal fetal potential is the fetal head flexion, the two arms cross over the front chest, and the two lower limbs are flexed in front of the abdomen. The volume and body surface area are significantly reduced. The whole carcass becomes a small elbow with a small end and a large buttock to accommodate pregnancy. The shape of the late elliptical uterine cavity. The normal uterus is 5.5 to 7.5 cm long, 4.5 to 5.5 cm wide, 3.0 to 4.0 cm thick, and 2.5 to 3.0 cm long. Under normal conditions, the three values ​​add up to more than 12 cm. The uterine cavity is inverted triangle, about 6 cm deep, and the upper two corners are "uterine horns" leading to the fallopian tubes. The lower end is narrowed to "isthmus" and is about 1 cm long. The isthmus gradually expands during pregnancy and forms the lower uterus during labor. The ratio of uterus to cervix varies from age to age, 1:2 in infancy, 1:1 in puberty, and 2:1 in childbearing period. Clinical significance Abnormal result The fetal-type oblique-produced baby has a certain angle of inclination to the direction of the mother's spine. The transverse direction of the baby's spine is in a "T" shape with the direction of the mother's spine. The fetal position pillow is exposed first - the left front of the pillow (LOA), the left side of the pillow (LOT), the left side of the pillow (LOP); the right front of the pillow (ROA), the right side of the pillow (ROT), the right rear of the pillow (ROP). First exposed – LMA, LMT, LMP, RMA, RMT, RMP. Buttocks first - 骶 left front (LSA), 骶 left horizontal (LST), 骶 left rear (LSP); 骶 right front (RSA), 骶 right horizontal (RST), 骶 right rear (RSP). Shoulder first - shoulder left front (LScA), shoulder left rear (LScP); shoulder right front (RScA), shoulder right rear (RScP). Fetal fetal position abnormalities include breech position, transverse position, posterior position of the occipital region, facial position, etc., more common in the breech position and posterior occipital position, less in the transverse position and facial position, abnormal fetal position accompanied by abnormal fetal position, difficult to correct, Should be used for abortion or caesarean section, uterine uterine dysplasia - the length, width and thickness of the uterus are less than 5 cm, 4 cm, 2 cm. The population needs to be examined for women after 24 weeks of gestation. Precautions Before the examination: After the pregnant woman urinates, lying on the examination bed, exposing the abdomen, the legs are slightly flexed and abducted, and the abdominal muscles are relaxed. When checking: Relax your body and actively cooperate with your doctor. Inspection process The first step: the examiner puts both hands on the bottom of the palace, and measures the height of the fundus by hand. According to its height, it is estimated whether the size of the fetus matches the pregnancy cycle. Afterwards, the two fingers are alternately nudged. If the fetal part of the fetus at the bottom of the palace is hard and round, it has a feeling of floating ball. If it is a fetal buttock, it is soft and irregular in shape. Step 2: The examiner puts both hands on the left and right sides of the abdomen and gently presses it to check. Touch the flat full part to the back of the tire and make sure the back of the tire is forward, sideways or backward. Touching the deformable uneven part is the fetal limb, and sometimes the fetal limb is active. The third step: the examiner's right thumb is separated from the other 4 fingers, placed above the pubic symphysis to hold the exposed part of the tire, to further find out whether it is the fetal head or the fetal buttocks, and push it to determine whether it is connected. If it can be promoted, it will not be connected. The fourth step: the examiner's right and left hands are placed on both sides of the first exposed part of the tire, and pressed down along the entrance of the pelvis to further verify whether the diagnosis of the first exposed part of the tire is correct, and determine the degree of the first exposed part of the tire. When the exposed part is the fetal head, one hand can smoothly enter the entrance of the pelvis, and the other hand is blocked by the fetal head bulge. The raised part is called the fetal head bulge. When the pillow is first exposed, the fetal head bulge is the frontal bone, which is on the same side as the fetal limb; when the face is first exposed, the fetal head bulge is the occipital bone, which is on the same side as the fetal back. Not suitable for the crowd Inappropriate crowd: women in early pregnancy.