Abdominal Palpation for Abdominal Palpation for Fetal PositionFetal Position

PurposePurpose

1.1. Determine the Determine the positionposition of of the baby in utero the baby in utero

2.2. Determine the Determine the expected expected presentationpresentation during labor during labor and delivery and delivery

Questions to ask yourself when performing the Questions to ask yourself when performing the abdominal palpation examination:abdominal palpation examination:

1.1. Is the fundal height consistent with the fetal Is the fundal height consistent with the fetal maturity?maturity?

2.2. Is the, transvelie longitudinalrse or oblique?Is the, transvelie longitudinalrse or oblique?3.3. Is the presentation cephalic or breech? Is the presentation cephalic or breech? 4.4. If cephalic, is the attitude vertex or facial? If cephalic, is the attitude vertex or facial? 5.5. What is the position of the denominator? What is the position of the denominator? 6.6. Is the vertex engaged?Is the vertex engaged?

The fetal The fetal lielie is either: is either:

LongitudinalLongitudinalo long axis of the fetus is alligned to the mother’slong axis of the fetus is alligned to the mother’so this is the only NORMAL positionthis is the only NORMAL position

TransverseTransverseo long axis of the fetus is perpendicular to that of the long axis of the fetus is perpendicular to that of the

mother’smother’s ObliqueOblique

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

Fetal LieFetal Lie

The The presentationpresentation is either: is either:

VertexVertexo head down in the pelvishead down in the pelvis

BrowBrow FacialFacial

Breech Breech o head is up in the uterine fundus head is up in the uterine fundus

and the buttocks is down in the and the buttocks is down in the pelvispelvis

ShoulderShoulder

AttitudeAttitude

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

o Flexed o Deflexed o Extended

DenominatorDenominator

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

OcciputOcciput - O- OSacrumSacrum - S - S MentumMentum - M- MFrontalFrontal - F- FAcromionAcromion - AC - AC or Scapulaor Scapula SCSC

PRESENTATIOPRESENTATIONN

ATTITUDEATTITUDE DENOMINATORDENOMINATOR

VertexVertex FlexedFlexed OcciputOcciput

BrowBrow Deflexed Deflexed (vertex)(vertex) FrontalFrontal

FacialFacial Extended Extended (vertex)(vertex) MentumMentum

BreechBreech SacrumSacrum

ShoulderShoulder Acromion/ Acromion/ ScapulaScapula

Flexed Vertex PresentationFlexed Vertex Presentation8 Possibilities8 Possibilities

LOL LOL ROLROL LOALOA ROAROA

ROPROPLOP LOP OPOPOAOA

• Full/Complete BreechFull/Complete Breecho arms & legs flexed in thearms & legs flexed in theo fetal positionfetal position

• Incomplete BreechIncomplete Breech• Frank BreechFrank Breech

o arms flexed but legs arms flexed but legs extended straight up over extended straight up over headhead

• Footling BreechFootling Breecho one or both feet extended one or both feet extended

downward and may exit the downward and may exit the birth canal firstbirth canal first

EngagementEngagement

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

o This is usually done by dividing the head into This is usually done by dividing the head into ”fifths””fifths”o if the head is still palpable abdominally, it is if the head is still palpable abdominally, it is

“2/5” or less engaged“2/5” or less engaged

Leopold’s ManeuverLeopold’s Maneuver

PURPOSESPURPOSES To provide information about fetal To provide information about fetal

presentation, position, presenting part i.e. lie, presentation, position, presenting part i.e. lie, attitude, and descentattitude, and descent

To aid in location of fetal heart ratesTo aid in location of fetal heart rates

To aid in assessment of fetal sizeTo aid in assessment of fetal size

To determination of single versus multiple To determination of single versus multiple gestationgestation

Leopold’s ManeuverLeopold’s Maneuver

Four-part process Four-part process

Palpation of fetal Palpation of fetal position in-uteroposition in-utero

PreparationPreparation

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

Place a small rolled towel under her right hipPlace a small rolled towel under her right hip

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

First ManeuverFirst Maneuver Facing the mother, palpate theFacing the mother, palpate the

fundus with both handsfundus with both hands– Assess for shape, size, consistency and mobilityAssess for shape, size, consistency and mobility

Fetal head: firm, hard, and roundFetal head: firm, hard, and round– Moves independently of the restMoves independently of the rest– Detectable by ballotementDetectable by ballotement

Breech/buttocks: softer and has bony prominencesBreech/buttocks: softer and has bony prominences– Moves with the rest of the formMoves with the rest of the form

Second ManeuverSecond ManeuverDetermine position of the back.Determine position of the back.

Still facing the mother, place both palms on the Still facing the mother, place both palms on the abdomenabdomeno Hold R hand still and with deep but gentle pressure, Hold R hand still and with deep but gentle pressure,

use L hand to feel for the use L hand to feel for the firm, smooth back firm, smooth back o Repeat using opposite handsRepeat using opposite hands

Confirm your findings by palpating the fetal Confirm your findings by palpating the fetal extremities on the opposite side extremities on the opposite side o small protrusions, “lumpy”small protrusions, “lumpy”

Third ManeuverThird Maneuver

Determine what part is lyingDetermine what part is lyingabove the inlet.above the inlet.

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

Confirm presenting part Confirm presenting part (opposite of what’s in the fundus)(opposite of what’s in the fundus)

Head will feel firmHead will feel firm Buttocks will feel softer and irregularButtocks will feel softer and irregular

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

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

Fourth ManeuverFourth Maneuver

1.1. Locate brow.Locate brow.2.2. Assess descent of the presenting part.Assess descent of the presenting part.

Turn to face the woman’s feetTurn to face the woman’s feet Move fingers of both hands gently down Move fingers of both hands gently down

the sides of the abdomen towards the the sides of the abdomen towards the pubis pubis

- Palpate for the cephalic prominence (vertex)- Palpate for the cephalic prominence (vertex)

Fourth Maneuver (cont’d)Fourth Maneuver (cont’d)

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

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