Abdominal Examination in Pregnancy

Systematic Examination Steps

The American College of Radiology recommends positioning the patient in left lateral tilt (15-30 degrees) to prevent supine hypotension from inferior vena caval compression by the gravid uterus 1
The American College of Radiology suggests assessing fundal height by measuring from the pubic symphysis to the uterine fundus, which should correlate with gestational age in centimeters after 20 weeks 2
The American College of Radiology recommends performing Leopold's maneuvers (after 28 weeks) to determine fetal lie, presentation, position, and engagement 2
The Journal of the American College of Radiology advises palpating systematically for masses, organomegaly, or areas of tenderness outside the gravid uterus, recognizing that anatomical displacement occurs as pregnancy progresses 3
The American College of Radiology recommends evaluating uterine tone and tenderness to detect potential placental abruption or uterine rupture if trauma is present 4
The Journal of the American College of Radiology suggests auscultating fetal heart tones using Doppler ultrasound, with normal fetal heart rate ranging from 110-160 beats per minute 2
Gastroenterology recommends listening for bowel sounds in all four quadrants, noting that decreased motility is physiological in pregnancy due to progesterone effects 5, 1

The Journal of the American College of Radiology notes that the appendix migrates superiorly and laterally as the uterus enlarges, so appendicitis pain may not localize to McBurney's point in the second and third trimesters 3, 4
The American College of Radiology states that physiologic hydronephrosis occurs in >80% of pregnant patients (more commonly on the right), typically beginning in the second trimester, and should not be automatically attributed to pathology 6

The American College of Radiology recommends immediate recognition of uterine rupture through severe abdominal pain, loss of fetal heart tones, and palpable fetal parts outside the uterus 4
The Journal of the American College of Radiology advises that appendicitis is the most common cause requiring emergency surgery in pregnancy, with atypical presentation due to anatomical displacement 3, 4
The American College of Radiology suggests that cholecystitis presents with right upper quadrant tenderness and positive Murphy's sign, diagnosed via ultrasound showing gallbladder wall thickening >3mm 4
The American College of Radiology recommends that ovarian torsion manifests as acute unilateral lower abdominal pain with a palpable adnexal mass 4

The Annals of Oncology recommends maintaining left lateral tilt positioning throughout the examination to optimize cardiac output and prevent maternal hypotension 9, 1
The American College of Radiology suggests monitoring maternal vital signs including blood pressure and heart rate, recognizing that pregnancy creates a hyperdynamic circulatory state 1
The American College of Radiology advises assessing for vaginal bleeding as part of the complete examination, as this may indicate obstetric complications 4