Abdominal palpation for fetal position
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Abdominal Palpation for Fetal Position. Purpose. Determine the position of the baby in utero Determine the expected presentation during labor and delivery . Questions to ask yourself when performing the exam:. Is the fundal height consistent with the fetal maturity?

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Purpose l.jpg
Purpose

  • Determine the position of the baby

    in utero

  • Determine the expected presentation during labor and delivery


Questions to ask yourself when performing the exam l.jpg
Questions to ask yourself when performing the exam:

  • Is the fundal height consistent with the fetal maturity?

  • Is the lie longitudinal, transverse or oblique?

  • Is the presentation cephalic or breech?

  • If cephalic, is the attitude vertex or facial?

  • What is the position of the denominator?

  • Is the vertex engaged?


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The lie is either:

  • Longitudinal

    • long axis of the fetus is alligned to the mother’s

    • this is the only NORMAL position

  • Transverse

    • long axis of the fetus is perpendicular to that of the mother’s

  • Oblique

    • long axis of the fetus is 0-90 degrees (or 90-180 degrees) to that of the mother’s




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The presentation is either:

  • Vertex

    • head down in the pelvis

  • Brow

  • Facial

  • Breech

    • head is up in the uterine fundus and the buttocks is down in the pelvis

  • Shoulder


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Attitude

  • The attitude is the relationship of the fetal parts to each other:

  • Flexed

  • Deflexed

  • Extended


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Denominator

  • The denominator (center identifying letter) is the fetal part presenting itself

    Occiput O

    Sacrum S

    Mentum M

    Frontal F

    Acromion AC or Scapula SC


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  • Lie

    • Longitudinal

  • Presentation

    • Breech

  • Denominator

    • Sacrum


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Flexed Vertex Presentation8 Possibilities

  • LOL

  • ROL

  • LOA

  • ROA

  • ROP

  • LOP

  • OP

  • OA


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Position

Posterior (OP) Lateral (LOL)


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  • Full/Complete Breech

    • arms & legs flexed in the

      fetal position

  • Incomplete Breech

  • Frank Breech

    • arms flexed but legs

      extended straight up over

      head

  • Footling Breech

    • one or both feet extended downward and may exit the birth canal first


Engagement l.jpg
Engagement

  • Determined by the amount of head that is above or below the pelvic brim

  • This is usually done by dividing the head into ”fifths”

    • if the head is still palpable abdominally, it is “2/5” or less engaged


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Leopold’s Maneuver

Adapted from Mosby’s Guide to Physical Exam, 6th Ed., Ch. 17


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Leopold’s Maneuver

  • Four-part process

  • Palpation of fetal position in-utero


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Preparation

  • Woman is supine, head slightly elevated and knees slightly flexed

  • Place a small rolled towel under her right hip

    If the doctor is R handed, stand at the woman’s R side facing her for the first 3 steps, then turn and face her feet for the last step (L handed, left side).


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First Maneuver

  • Facing the mother, palpate the

    fundus with both hands

    • Assess for shape, size, consistency and mobility

  • Fetal head: firm, hard, and round

    • Moves independently of the rest

    • Detectable by ballotement

  • Breech/buttocks: softer and has bony prominences

    • Moves with the rest of the form


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Second Maneuver

Determine position of the back.

  • Still facing the mother, place both palms on the abdomen

    • Hold R hand still and with deep but gentle pressure, use L hand to feel for the firm, smooth back

    • Repeat using opposite hands


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Second Maneuver (cont’d)

Once you’ve located the back…

  • Confirm your findings by palpating the fetal extremities on the opposite side

    • small protrusions, “lumpy”


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NOTE

Start building a mental image.

Where’s the baby?

  • Back connects to the part of the fetus you determines was in the fundus…


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Third Maneuver

Determine what part is lying

above the inlet.

  • Gently grasp the lower portion of the abdomen (just above symphisis pubis) with the thumb and fingers of the R hand

  • Confirm presenting part

    (opposite of what’s in the fundus)


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  • Head will feel firm

  • Buttocks will feel softer and irregular

  • If it’s not engaged, it may be gently pushed back and forth

    Proceed to the 4th step if it’s not engaged…


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Fourth Maneuver

  • Locate brow.

  • Assess descent of the presenting part.

  • Turn to face the woman’s feet

  • Move fingers of both hands gently down the sides of the abdomen towards the pubis

    • Palpate for the cephalic prominence (vertex)


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Fourth Maneuver (cont’d)

  • Prominence on the same side as the small parts suggests that the head is flexed (optimum)

  • Prominence on the same side as the back suggests that the head is extended


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