II. Exam: Leopold's Maneuvers
- First Maneuver (Upper pole)
- Examiner faces woman's head
- Palpate uterine fundus
- Determine what fetal part is at uterine fundus
- Second Maneuver (Sides of maternal Abdomen)
- Examiner faces woman's head
- Palpate with one hand on each side of Abdomen
- Palpate fetus between two hands
- Assess which side is spine and which extremities
- Third Maneuver (Lower pole)
- Examiner faces woman's feet
- Palpate just above Symphysis Pubis
- Palpate fetal presenting part between two hands
- Assess for Fetal Descent
- Fourth Maneuver (Presenting part evaluation)
- Examiner faces woman's head
- Apply downward pressure on uterine fundus
- Hold presenting part between index finger and thumb
- Assess for cephalic versus Breech Presentation
III. Exam: Focus areas for abdominal palpation
- Assess Fundal Height
- Fundal height (cm) approximates weeks of gestation
- Assess Fetal Lie
- Longitudinal (Normal)
- Transverse
- Oblique
- Assess Fetal Presentation
- Breech Presentation
- Cephalic Presentation
- Vertex Presentation (Normal attitude: Full flexion)
- Face Presentation (Abnormal attitude: Head extends)
- Assess Fetal Vertex Position
- Palpate the sagittal Suture (may be obscured by caput)
- Anterior Fontanelle has 4 adjacent Suture lines
- Posterior Fontanelle has 3 adjacent Suture lines
- Palpate ear position
- Positions
- Left Occiput Lateral (LOL) 40%
- Left Occiput Anterior (LOA) 12%
- Left Occiput Posterior (LOP) 3%
- Right Occiput Lateral (ROL) 25%
- Right Occiput Anterior (ROA) 10%
- Right Occiput Posterior (ROP) 10%
- Palpate the sagittal Suture (may be obscured by caput)
- Assess Fetal Descent
- Is Vertex engaged?
IV. Other methods of determining Fetal Orientation
- Obstetric Ultrasound
- Digital cervical exam