rle leopolds

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Definition of Terms

Fundus ² Latin word for bottom. In OB, fundus is the

base of the uterus



Symphysis pubis - The area in the front of the

pelvis where the pubic bones (the two bones of the

pubis) meet.



FETAL ATTITUDE- describes the degree of flexion a fetus assumes during labor or

the relation of the fetal parts to each other.Suboccipito-bregmatic

(Vertex) ² good

attitude because of

complete flexion: spine

is bowed forward,

head flexed forward

so much that the chin

touches the sternum,

the arms are flexedand folded on the

chest, thighs are flexed

onto the abdomen.



Occipitofrontal ²

moderate flexion if the

chin is not touching the

chest.

�Military position



Brow presentation ²

partial extension

present the ´browµ of

the head



Occipitomental ² poor

flexion, complete

extension of the head

to the birth canal

� This position occurs if

the amount of amniotic

fluid is less than normal

which does not allow

the fetus adequate

movement.





FETAL PRESENTATION

- denotes the body part that will firstcontact the cervix or be born first.

Cephalic presentation ² the fetal head is the body

part that will first contact the cervix.

Breech presentation ² either the buttocks or the

feet are the first body parts that will contact the

cervix.

Shoulder presentation ² a fetus lie horizontally inthe pelvis. The presenting part is usually one of the

shoulder (acromion process), an iliac crest, a hand,

or an elbow



Complete breech ²

the fetus thighs tightly

flexed on the

abdomen; both the

bottocks and the

tigthly flexed feet

present to the cervix



Incomplete Breech



Frank Breech

presentation ²

attitude is moderate

because the hips are

flexed but the knees

are extended to rest

on the chest. The

buttocks alone present

to the cervix.



Footling Breech

presentation ² neither

the thighs nor the

lower legs are flexed.

If one foot is presents,

it is a single-footling

breech; if both present,

it is a double-footling

breech.







Shoulder Presentation



Fetal Position

Position is the relationship of the presenting part to

the specific quadrant of a woman·s pelvis

The maternal pelvis is divided into for quadrant

according to mother·s right and left

a. Right anterior

b. Left anterior

c. Right posteriord. Left anterior



Four parts of a fetus have been chosen as landmark

to describe the relationship of the presenting part

to one of the pelvic quadrants:

a. OCCIPUT in vertex position

b. CHIN (MENTUM) in face presentation

c. SACRUM in breech presentation

d. SCAPULA or the ACROMION in shoulder presentation



Examples:

LEFT

OCCIPUTOANTERIOR

LEFT MENTOTRANSVERSE



LEFT

SACROPOSTERIOR



FETAL POSITION



EXPECTED DATE OF CONFINEMENT

NAGELE·S RULE

� To calculate the date of birth, count backward 3

calendar months from the first day of the LMP and add

7 days.

� Example:

� LMP: January 3



What is the EDC?

LMP: April 25, 2011

LMP: January 18, 2010

LMP: June 13, 2012



McDONALD·S RULE

A symphysis-fundal height measurement is a

common method of determining, during

midpregnancy, that a fetus is growing in utero.

The distance from the uterine fundus to the

symphysis pubis in centimeter is equal to the week

of gestation between 20th-31st weeks of pregnancy.

12 weeks AOG ² symphysis pubis 20 weeks AOG ² umbilicus

36 weeks AOG ² xiphoid process





LEOPOLD·S MANEUVERS

Are a systematic method of observation and

palpation to determine fetal presentation and

position.



PROCEDURES

PREPARE THE CLIENT

� Explain the procedure

� Instruct the client to empty he bladder

� Position the woman supine with knees slightly flexed.

Place a small pillow or rolled towel under one side.

�Wash your hands using warm water.

�

Observe the woman·s abdomen for longest diameterand where fetal movement is apparent.



PERFORM THE FIRST MANEUVER

� Stand at the foot of the client, facing her and place

both hands flat on her abdomen.

� Palpate the superior surface of the fundus. Determine

the consistency, shape and mobility.





PERFORM THE SECOND MANEUVER

� Face the client and place the palms of each hand either

side of the abdomen.

� Palpate the sides of the uterus. Hold the left hand

stationary on the left side of the uterus while right hand

palpates the opposite side of the uterus from top to

bottom. Then hold the right hand steady and repeat

palpation using the left hand on the left side.





PERFORM THE THIRD MANEUVER

�Gently grasp the lower portion of the abdomen just

above the symphysis pubis between the thumb and the

index finger together. Determine any movement andwhatever the pat firm or soft.





PERFORM THE FOURTH MANEUVER

� Palpate finger on the both sides of the uterus

approximately 2 inches above the inguinal ligament,

pressing downward and inward in the direction of thebirth canal. Allow fingers to be carried downward.



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