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Abdominal Palpation for

Fetal Position
Purpose

1. Determine the position of


the baby in utero
2. Determine the expected
presentation during labor
and delivery
Questions to ask yourself when performing the
abdominal palpation examination:

1. Is the fundal height consistent with the fetal


maturity?
2. Is the, transvelie longitudinalrse or oblique?
3. Is the presentation cephalic or breech?
4. If cephalic, is the attitude vertex or facial?
5. What is the position of the denominator?
6. Is the vertex engaged?
The fetal lie is either:

Longitudinal
o long axis of the fetus is alligned to the mothers
o this is the only NORMAL position
Transverse
o long axis of the fetus is perpendicular to that of the
mothers
Oblique
o long axis of the fetus is 0-90 degrees (or 90-180 degrees)
to that of the mothers
Fetal Lie
The presentation is either:

Vertex
o head down in the pelvis

Brow
Facial

Breech
o 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:
o Flexed
o Deflexed
o 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


Deflexed
Brow Frontal
(vertex)
Extended
Facial Mentum
(vertex)
Breech Sacrum
Acromion/
Shoulder
Scapula
Flexed Vertex Presentation
8 Possibilities

LOL ROP
ROL LOP
LOA OP
ROA OA
Full/Complete Breech
o arms & legs flexed in the
o fetal position
Incomplete Breech
Frank Breech
o arms flexed but legs
extended straight up over
head

Footling Breech
o 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
o This is usually done by dividing the head into
fifths
o if the head is still palpable abdominally, it is
2/5 or less engaged
Leopolds 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
Leopolds 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 womans 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
o Hold R hand still and with deep but gentle pressure,
use L hand to feel for the firm, smooth back
o Repeat using opposite hands

Confirm your findings by palpating the fetal


extremities on the opposite side
o 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 whats in the fundus)
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


Fourth Maneuver

1. Locate brow.
2. 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)
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

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