1. Leopold’s - Abdominal Palpation for Fetal Position

2. The lie is either: Longitudinal Transverse Oblique
long axis of the fetus is aligned 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 degrees) to that of the mother’s

3. Longitudinal
Longitudinal
Transverse

4. The presentation is either:
Vertex
head down in the pelvis
Brow
Facial
Breech
head is up in the uterine fundus and the buttock in the pelvis
Shoulder

5. Attitude Relationship of fetal parts to each other: Flexed Deflexed
Extended

6. Denominator
The denominator is a “letter” that represents the presenting fetal part
Used in the listing system
Occiput O
Sacrum S
Mentum M
Frontal F
Acromion AC or Scapula SC

7. PRESENTATION
ATTITUDE
DENOMINATOR
Vertex
Flexed
Occiput
Brow
Deflexed (vertex)
Frontal
Facial
Extended (vertex)
Mentum
Breech
Sacrum
Shoulder
ACromion/ Scapula

8. Lie
Longitudinal
Presentation
Breech
Denominator
Sacrum

9. Flexed Vertex Presentation 8 Possibilities
LOL
ROL
LOA
ROA
ROP
LOP OP OA OA
ROA
LOA
ROL
LOL
ROP OP
LOP

10. Posterior (OP) Lateral (LOL)

11. Full/Complete Breech Incomplete Breech Frank Breech Footling 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

12. 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
Stations of Presentation

13. Leopold’s Maneuver Four-part process
Determine the position of the baby in utero
Determine the expected presentation during labor and delivery

14. 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?

15. 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).

16. First Maneuver What part is in the fundus?
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
Buttocks/breech: softer and has bony prominences
Moves with the rest of the form

17. 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
Once you’ve located the back, confirm your findings by palpating the fetal extremities on the opposite side (“lumpy”)

18. Third Maneuver Determine what part is lying above the inlet.
Gently grasp 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
If it’s not engaged, it may be gently pushed back and forth
Proceed to the 4th step if it’s not engaged…

19. Fourth Maneuver Flexed/Deflexed/Extended?
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)
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

20. Intro to Using a Fetoscope

21. Fetal Monitoring Equipment
Fetal heart Rate (FHR) can be determined by use of:
Fetoscope or Leff scope
specifically designed instruments
Clinical stethescope
Electronic Doppler

22. Doppler Method Employs a continuous ultrasound
Can detect the fetal heart at weeks’ gestation
Amplifiers allow both the practitioner and parents to hear

23. Fetoscope Has a band that fits against the head of the listener
makes handling of the instrument unnecessary
aids in bone conduction of sound
Can pick up the fetal heart rate at weeks’ gestation

24. Fetoscope Fetal heart tones are best heard over the baby’s back
Used in conjunction with Leopold’s maneuver
Auscultation may be difficult if…
Mother is overweight
Placenta is in the front of the uterus
*Always easier in later stages of the pregnancy

25. Where will you hear the FHTs?

26. Preparation Let her empty her bladder Be sure the room is quiet
Patient lies supine
If more than 28 weeks pregnant, place a small rolled towel under R hip
relieves pressure on abdominal aorta

27. Procedure Place the padded cone just above the pubic bone
Headpiece solid against the forehead
Exert slight pressure into the abdomen
Slowly rotate the cone 360 degrees, looking for the heart tones
Must be directed at the baby’s heart to hear FHT
If nothing is heard…
Move the instrument up toward the umbilicus 1cm and repeat

28. If FHTs are still not heard…
If you have not heard the heart tones when you reach a position half-way between the pubic bone and the umbilicus…
Move 1cm to the side of midline
Proceed back down to the pubic bone
If FHTs are still not heard…
Do the same on the other side
Again, move the cone 1 cm at a time and rotate the instrument 360 degrees at each new position

30. Fetal Heart Rate Count the FHTs for 15 seconds Multiply by 4
( ) x 4 = ___ per minute
To be more accurate, you may want to take more than one 15 second “sample”
sleeping = slower HR
moving = faster HR