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Abdominal Palpation for Fetal Position

Abdominal Palpation for Fetal Position

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Abdominal Palpation for Fetal Position

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  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 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?

  4. The 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

  5. Longitudinal

  6. Transverse Lie

  7. 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

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

  9. 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

  10. Lie • Longitudinal • Presentation • Breech • Denominator • Sacrum

  11. Flexed Vertex Presentation8 Possibilities • LOL • ROL • LOA • ROA • ROP • LOP • OP • OA

  12. Position Posterior (OP) Lateral (LOL)

  13. 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

  14. 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

  15. Leopold’s Maneuver Adapted from Mosby’s Guide to Physical Exam, 6th Ed., Ch. 17

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

  17. 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 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).

  18. 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

  19. 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

  20. Second Maneuver (cont’d) Once you’ve located the back… • Confirm your findings by palpating the fetal extremities on the opposite side • small protrusions, “lumpy”

  21. NOTE Start building a mental image. Where’s the baby? • Back connects to the part of the fetus you determines was in the fundus…

  22. 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)

  23. 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…

  24. 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)

  25. 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