Abdominal Palpation for Fetal Position The presentation is either:

Purpose  Vertex
1. Determine the position of the baby in utero o head down in the pelvis
2. Determine the expected presentation during  Brow
labor and delivery  Facial
Questions to ask yourself when performing the o Breech
abdominal palpation examination: o head is up in the uterine fundus and the
1. Is the fundal height consistent with the fetal buttocks is down in the pelvis
maturity? o Shoulder
2. Is the, transvelie longitudinalrse or oblique?
3. Is the presentation cephalic or breech?
4. If cephalic, is the attitude vertex or facial?
5. What is the position of the denominator?
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
90-180 degrees) to that of the mother’s

Attitude
 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
Sacrum -S
Mentum -M
Frontal -F
Acromion - AC or Scapula SC
 Leopold’s Maneuver
Flexed Vertex Presentation  To provide information about fetal
8 Possibilities presentation, position, presenting part i.e. lie,
 LOL attitude, and descent
 ROL  To aid in location of fetal heart rates
 LOA  To aid in assessment of fetal size
 ROA  To determination of single versus multiple
 ROP gestation
 LOP  Four-part process
 OP  Palpation of fetal position in-utero
• OA
Full/Complete Breech Preparation
o arms & legs flexed in the  Woman is supine, head slightly elevated and
o fetal position knees slightly flexed
• Incomplete Breech  Place a small rolled towel under her right hip
• Frank Breech If the nurse is R handed, stand at the woman’s
o arms flexed but legs extended straight R side facing her for the first 3 steps, then turn and
up over head face her feet for the last step (L handed, left side).
• Footling Breech First Maneuver: FUNDAL GRIP
o one or both feet extended downward  Facing the mother, palpate the
and may exit the birth canal first 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
 Breech/buttocks: softer and has bony
prominences
– Moves with the rest of the form
Second Maneuver: UMBILICAL GRIP
Determine position of the back.
 Still facing the mother, place both palms on
the abdomen
o Hold R hand still and with deep but
Engagement gentle pressure, use L hand to feel for
 Determined by the amount of head that is the firm, smooth back
above or below the pelvic brim o Repeat using opposite hands
o This is usually done by dividing the head into  Confirm your findings by palpating the fetal
”fifths” extremities on the opposite side
o if the head is still palpable o small protrusions, “lumpy”
abdominally, it is “2/5” or less engaged

Third Maneuver: PAWLIK’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
  If it’s not engaged, it may be gently pushed
back and forth
 Proceed to the 4th step if it’s not engaged…

Fourth Maneuver : PELVIC GRIP

1. Locate brow.
2. Assess descent of the presenting part.
 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