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 abdominal palpation examination: Is the fundal height consistent with the fetal maturity? Is the, transvelie longitudinalrse 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?

The fetal 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

Fetal Lie

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

Attitude The attitude is the relationship of the fetal parts to each other: Flexed Deflexed Extended

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

PRESENTATION ATTITUDE DENOMINATOR Vertex Flexed Occiput Brow Deflexed (vertex) Frontal Facial Extended (vertex) Mentum Breech Sacrum Shoulder Acromion/ Scapula

Flexed Vertex Presentation 8 Possibilities LOL ROL LOA ROA ROP LOP OP OA

Full/Complete Breech Incomplete Breech Frank Breech Footling 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 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

Leopold’s Maneuver

PURPOSES To provide information about fetal presentation, position, presenting part i.e. lie, attitude, and descent To aid in location of fetal heart rates To aid in assessment of fetal size To determination of single versus multiple gestation

Leopold’s Maneuver Four-part process Palpation of fetal position in-utero

Preparation Woman is supine, head slightly elevated and knees slightly flexed Place a small rolled towel under her right hip If the nurse 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).

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

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

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)

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…

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)

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