Antenatal careAntenatal care

X iu Xiu JiangX iu Xiu Jiang

TermsTerms Fetal lieFetal lie the relationship of the long axis of the fetus to that of the the relationship of the long axis of the fetus to that of the

mother. mother. If the two are parallel, then the fetus is said to be in a If the two are parallel, then the fetus is said to be in a

longitudinal lie longitudinal lie (present in over 99 percent of labors at term).(present in over 99 percent of labors at term). If the two are at 90-degree angles to each other, the fetus is If the two are at 90-degree angles to each other, the fetus is

said to be in a said to be in a transverse lietransverse lie. . If the fetal and the maternal axes may cross at a 45-degree If the fetal and the maternal axes may cross at a 45-degree

angle, forming an angle, forming an oblique lieoblique lie, which is unstable and always , which is unstable and always becomes longitudinal or transverse during the course of labor.becomes longitudinal or transverse during the course of labor.

Fetal presentationFetal presentation

The portion of the fetal body that is either The portion of the fetal body that is either foremost within the birth canal or in closest foremost within the birth canal or in closest proximity to it proximity to it

In longitudinal lies, the presenting part is either In longitudinal lies, the presenting part is either cephaliccephalic or or breech presentationsbreech presentations, respectively., respectively.

In transverse lie, the In transverse lie, the shouldershoulder is the presenting is the presenting part.part.

cephalic presentation breech presentation shoulder presentation

Types of Cephalic presentationTypes of Cephalic presentation

Vertex or occiput presentation

Sinciput presentation

brow presentation face presentation

Types of breech presentationTypes of breech presentation

Frank typeFrank type Complete typeComplete type incomplete type or footling incomplete type or footling presentationpresentation

Fetal positionFetal position

Refers to the relationship of an arbitrarily chosen portion of Refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal the fetal presenting part to the right or left side of the maternal birth canal. birth canal.

The dertermining points in The dertermining points in vertexvertex, , faceface, and , and breechbreech presentations are fetal presentations are fetal occiputocciput, , chin (mentum),chin (mentum), and and sacrumsacrum respectively. respectively.

The presenting part in right or left positions may be directed The presenting part in right or left positions may be directed anteriorly (A), transversely (T), or posteriory (P).anteriorly (A), transversely (T), or posteriory (P). There are six There are six varieties of each of the three presentations. varieties of each of the three presentations.

Fetal positions of cephalic presentation

Fetal positions of breech presentation

Diagnosis of fetal presentation and Diagnosis of fetal presentation and positionposition

Abdominal palpation Abdominal palpation (Leopold maneuver)(Leopold maneuver) Vaginal examinationVaginal examination AuscultationAuscultation imaging studies: ultrasonography, imaging studies: ultrasonography,

computed tomography, or magnetic computed tomography, or magnetic resonance imagingresonance imaging

Leopold maneuverLeopold maneuver Leopold maneuver is established by Leopold in1848Leopold maneuver is established by Leopold in1848 Preparations before examinationPreparations before examination Instruct woman to empty her bladder first. Instruct woman to empty her bladder first. Place woman Place woman in dorsal recumbent positionin dorsal recumbent position, supine with knees , supine with knees

flexed to relax abdominal muscles. Place a small pillow under flexed to relax abdominal muscles. Place a small pillow under the head for comfort. the head for comfort.

Drape properly to maintain privacy Drape properly to maintain privacy Explain procedure to the patient. Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate Warms hands by rubbing together. (Cold hands can stimulate

uterine contractions). uterine contractions). Use the palm for palpation not the fingersUse the palm for palpation not the fingers

First Maneuver: First Maneuver: To determine fetal part lying in the fundus. To determine fetal part lying in the fundus.

To determine presentation. To determine presentation.

procedure:procedure: Using both hands, feel for the Using both hands, feel for the fetal part lying in the fundus.fetal part lying in the fundus.

Head Head is more firm, hard and round, and is is more firm, hard and round, and is more mobile and ballottable.more mobile and ballottable.

BreechBreech feels as a large, nodular mass. feels as a large, nodular mass.

Second Maneuver:Second Maneuver: To identify location of fetal back.To identify location of fetal back.

To determine position.To determine position.

ProcedureProcedure:: One hand is used to steady the One hand is used to steady the uterus on one side of the abdomen while uterus on one side of the abdomen while the other hand moves slightly on a the other hand moves slightly on a circular motion from top to the lower circular motion from top to the lower segment of the uterus to feel for the fetal segment of the uterus to feel for the fetal back and small fetal parts.back and small fetal parts.Use gentle but deep pressure.Use gentle but deep pressure.

Fetal backFetal back is smooth, hard, and resistant is smooth, hard, and resistant surfacesurfaceKnees and elbowsKnees and elbows of fetus feels with a of fetus feels with a number of small, irregular, mobile partsnumber of small, irregular, mobile parts

Third Maneuver: Third Maneuver: To determine engagement of To determine engagement of

presenting part.presenting part.

procedure:procedure: Using thumb and finger, Using thumb and finger, grasp the lower portion of the grasp the lower portion of the abdomen above symphisis pubis, press abdomen above symphisis pubis, press in slightly and make gentle in slightly and make gentle movements from side to side.movements from side to side.

The presenting part is engaged if it is The presenting part is engaged if it is not movable. not movable.

It is not yet engaged if it is still It is not yet engaged if it is still movablemovable

Fourth Maneuver:Fourth Maneuver: To determine if the presentation has To determine if the presentation has

descended into the pelvisdescended into the pelvis To determine the position of the fetal To determine the position of the fetal

presentationpresentation

procedure:procedure: Facing foot part of the Facing foot part of the woman, using the tips of the first three woman, using the tips of the first three fingers, exerts deep pressure in the fingers, exerts deep pressure in the direction of the axis of the pelvic inletdirection of the axis of the pelvic inlet

Use both hands.Use both hands.

Fundal Height

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