Abdominal Palpation for Fetal Position

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Abdominal Palpation for Fetal Position
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Purpose

• Determine the position of the baby
• in utero
• Determine the expected presentation during labor
  and delivery

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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
  mothers
• this is the only NORMAL position
• Transverse
• long axis of the fetus is perpendicular to that
  of the mothers
• Oblique
• long axis of the fetus is 0-90 degrees (or 90-180
  degrees) to that of the mothers

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Longitudinal
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Transverse Lie
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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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(No Transcript)
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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

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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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Leopolds Maneuver

• Adapted from Mosbys Guide to Physical Exam, 6th
  Ed., Ch. 17

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Leopolds 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 womans
  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 (contd)

• Once youve 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.
• Wheres 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 whats in the fundus)

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• Head will feel firm
• Buttocks will feel softer and irregular
• If its not engaged, it may be gently pushed back
  and forth
• Proceed to the 4th step if its not engaged

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Fourth Maneuver

• Locate brow.
• Assess descent of the presenting part.
• Turn to face the womans 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 (contd)

• 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