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systematic way to find out position, presentation, fetal lie, engagement done towards the end of pregnancy, to figure out where the baby is 3 rd trimester explain to mother what we are going to do, let pt void before ‐ empty bladder lay down supine with knees flexed, wedge under hip (so is not totally supine) may not work on obese or hydramnios
In the 1st three maneuvers, the nurse faces the head of the pt L 1- PALPATION OF THE FUNDUS What is in fundus ? palpate fundus, to find what is on the fundus, hope for soft (buttocks) and not hard (head). Fundus is gently palpated between the palms of two hands If fetus is in cephalic presentation the breech is felt in fundus (BREECH ‐ is softer & irregular than the head, there is no angle formed by the neck and the surface continues smoothly with the back If in breech presentation the head is in fundus (HEAD round, hard, ballotable mass) What is the Lie of the baby? Transferse Lie – Horizontal orientation ‐ baby is perpendicular to the long axis of the mother Longitudinal Lie – Vertical orintation ‐ baby is parellal to long axis of the mom upper pole (in this case the breech) is identified if in a transferse lie, L‐ 1 is negative •
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L 2 - PALPATION OF THE BODY- lateral sides of the fundus Where is fetal back? in 2nd, hands go down both side of mom’s abdomen, to determine fetal back (smooth side), other side is fetal part (elbow, hands, knees) Continues palpate down the body of the uterus – side of the mother Fetal back ‐ back ‐ smooth side, bony convex mass represents vertebral column Other side is fetal small parts – small irregular surface created by the limbs, elbow, knees hands, feet if transferse if transferse the head & buttuck will be located If you locate back, place the stethoscope at the back where FHR is most audibel In this picture ‐ smooth back is palpated and identified •
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L 3 – WHAT PART OF THE BABY LIES JUST ABOVE THE PELVIC INLET? Palpation of the vertex. 3rd maneuver, V PRESENTION grabbing the part part by the pubic pubic bone to feel if engaged. engaged. If moveable, it is ballottables, it is floating and not engaged. o If cannot be move, it is engaged (0 station) and is in pelvic inlet. o From L ‐ 3 – will know fetal presentation Use dominant hand and grab the part by the pubic bone to feel if engaged If you grab the head (feels hard, round and ballotable mass) – in the case head is in the lower pole If breech will feel soft irregular masses If movable, it is ballotable, floating and not engaged – you will grasp head and can move from side to side If cannot be move, it is engaged engaged (0 station) and is in pelvic inlet) If head If head is already descended, you will not feel the head W/partial descend – will feel shoulders of the baby If breech is palpated – OMIT L – 4 •
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L 4 - ASSESSING ENGAGEMENT – What is the ATTITUDE of the fetus? 4th maneuver, now facing pt. feet, palpate abdomen side for the eye brow position (will not do this if baby in breech position) •
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‐ to feel where to put monitor for fetal heart. Fetal attitude – is degree of flexion of the baby in the utero Facing the woman’s feet the vertex is palpated using both hands If in extension attitude ‐ there is resistance: your hands will feel depression and then will feel the ascending curve going toward the head If in complete flexion ‐ cephalic prominence is on the same side as the fetal small parts (feets and knees) If in complete extension ‐ cephalic prominence is on the same side of fetal back From L‐4 – know fetal attitude/ degree of flexion of the vertex & cephalic prominence
LEOPOLD MANEUVER
