1. Abdominal Palpation for Fetal Position

2. Purpose Determine the position of the baby in utero
Determine the expected presentation during labor and delivery

3. 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?

4. 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 degrees) to that of the mother’s

5. Fetal Lie

6. 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

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

8. 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

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

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

11. 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

12. 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

13. Leopold’s Maneuver

14. 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

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

16. 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).

17. 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

18. 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”

19. 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)

20. 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…

21. 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)

22. 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