NCM 107 RLE (Week 2 – Part 2): LEOPOLD”S MANUEVER o arms flexed but legs extended straight up

over head
Abdominal Palpation for Fetal Position  Footling Breech
Purpose: o one or both feet extended downward
1. Determine the position of the baby in utero and may exit the birth canal first
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? o head is up in the uterine fundus and the
4. If cephalic, is the attitude vertex or facial? buttocks is down in the pelvis
5. What is the position of the denominator?  Shoulder
6. Is the vertex engaged?
The fetal lie is either:
 Longitudinal
o long axis of the fetus is alligned to the
mother’s
o this is the only NORMAL position
 Transverse
o long axis of the fetus is perpendicular to that
of the mother’s
 Oblique
o long axis of the fetus is 0-90 degrees (or 90-
Attitude
180 degrees) to that of the mother’s
 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
The presentation is either: Sacrum -S
 Vertex Mentum -M
o head down in the pelvis Frontal -F
 Brow Acromion - AC or Scapula SC
 Facial PRESENTATIO ATTITUD
DENOMINATOR
o Breech N E
 Full/Complete Breech Vertex Flexed Occiput
o arms & legs flexed in the fetal position
 Incomplete Breech Deflexed
Brow Frontal
(vertex)
 Frank Breech
 Extended First Maneuver (Fundal Grip)
Facial Mentum  Facing the mother, palpate the fundus with both
(vertex)
hands
Breech Sacrum
– Assess for shape, size, consistency and
Acromion/ mobility
Shoulder
Scapula  Fetal head: firm, hard, and round
– Moves independently of the rest
Flexed Vertex Presentation 8 Possibilities – Detectable by ballotement
-LOL -ROP  Breech/buttocks: softer and has bony
-ROL -LOP prominences
-LOA -OP – Moves with the rest of the form
-ROA -OA Second Maneuver (Umbillical Grip)
Engagement Determine position of the back.
 Determined by the amount of head that is above  Still facing the mother, place both palms on the
or below the pelvic brim abdomen
 This is usually done by dividing the head into o Hold R hand still and with deep but
”fifths” gentle pressure, use L hand to feel for the
o if the head is still palpable abdominally, it firm, smooth back
is “2/5” or less engaged o Repeat using opposite hands
Leopold’s Maneuver  Confirm your findings by palpating the fetal
 Four-part process extremities on the opposite side
 Palpation of fetal position in-utero o small protrusions, “lumpy”
Third Maneuver (Pawlick’s Grip)
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
Purposes:  If it’s not engaged, it may be gently pushed back
 To provide information about fetal presentation, and forth
position, presenting part i.e. lie, attitude, and  Proceed to the 4th step if it’s not engaged…
descent Fourth Maneuver (Pelvic Grip)
 To aid in location of fetal heart rates 1. Locate brow.
 To aid in assessment of fetal size 2. Assess descent of the presenting part.
 To determination of single versus multiple  Turn to face the woman’s feet
gestation  Move fingers of both hands gently down the
Preparation: sides of the abdomen towards the pubis
 Woman is supine, head slightly elevated and - Palpate for the cephalic prominence (vertex)
knees slightly flexed  Prominence on the same side as the small parts
 Place a small rolled towel under her right hip suggests that the head is flexed (optimum)
If the nurse is R handed, stand at the woman’s R  Prominence on the same side as the back
side facing her for the first 3 steps, then turn and suggests that the head is extended
face her feet for the last step (L handed, left side).