Leupold's Maneuver Rationale

PREPARATORY PHASE - Introduce yourself to the client, verify the identity of the client and check the
wrist band in order to know if the name in the wrist band is congruent to what name the client might
tell you.

1. Leupold's Maneuver is a systematic palpation of the uterus, in order for us ma'am to know the
positioning of the baby inside your uterus, it is important because it will give us a hint as well of possible
malpositioning of the baby inside the uterus for the mother to be prepared, financially, physically and
emotionally.

2. To prevent discomfort to the patient, alterations of result and it might add up height to the fundus.

3. To prevent cross-contamination of diseases from nurse to patient and vice versa.

4. Dorsal Recumbent Position

5. To maintain the dignity of the client.

6.

7. To prevent contractions which can alter results, rub or warm the hands for atleast 5 sec.

8.

FIRST MANEUVER

- also known as fundal grip

- aims to know the fetal lie includes;

📍 Longitudinal

📍 Transverse

📍 Oblique

9.

10. Fetal parts includes:

📍 Hard round - fetal head

📍 Soft and symmetric - buttocks

📍 Bony processes - fetal limbs

📍 Hard resistance surface (flat) - back

2nd MANEUVER

- also known as umbilical grip

-aims to know the location of the fetal back

11. We should apply pressure to be able to palpate easily.

12.

13.

3RD Maneuver

-also known as pawlik's grip

- identify the fetal presentation includes:

📍 Cephalic which is normal

📍 Breech

📍 Shoulder

📍 Oblique

- determine engagement, if not engage proceed to the 4th maneuver.

14. After doing the procedure, I will push the presenting part, if it is pushed means it is not engage
proceed to the 4th maneuver, if it is engage, document the result and make the client comfortable.

4TH MANEUVER
- aims to know the fetal attitude includes vertex which is the normal one, and the abnormal ones such
as: military/sinciput, brow and face.

15. If there is no obstruction upon palpation means it is in good attitude, if it has means it's in bad
attitude.

FUNDIC HEIGHT MEASUREMENT RATIONALE

It is important for us to know the gestational age, to know if the mother is gaining weight or if the baby
is growing, it shows also how large the baby is and it is alternative for ultrasound.

📍 Tos mag measure na kw vina, tos Ibaytah mu bng pila then, sawpama 37 cm, yanun muna ing Inah
abt the results "so ma'am for your fundic height it is normal it is 37 cm, ur baby is in ur xiphoid process
so it is normal" because there is a study wherein after 24 weeks the number of height is same as the
number of weeks but it can increase 2 cm or might decrease 2 cm because the baby might be engaged,
after that record findings.

ANATOMICAL LANDMARKS

📍 Level of symphysis pubis - 12-14 weeks

📍 Umbilicus - 20-22 weeks

📍 Xiphoid process - 36 weeks

INDICATIONS FOR TOO LARGE

📍 Miscalculation

📍 Baby is bigger than the average

📍 Fatty stomach
📍 Full bladder or constipation

📍 Polyhydramnios - too much amniotic fluid.

FOR TOO SMALL

📍 Miscalculation

📍 Baby is smaller than the average

📍 Petite body type

📍 Oligohydramnios - too little amniotic fluid.

FHT MONITORING RATIONALE

5. It allows us to assess the fetal heart rate of the baby, to show if the baby shows signs of possible
problems and if to know if the baby is healthy.

8. Warm the bell to prevent contraction, if the abdomen is already contracting use the bell part then if it
is not use the diaphragm part of the stethoscope.

Between numbers 9 and 10 - compare the FHT with pulse of mother

11. Ibaytah ing normal, ex : Ma'am the baby's FHT is 120 bpm, it is in regular rhythm and no
abnormalities"

12.

13.

14.

REASONS WE DO THE FHT

📍 Diabetic

📍 If the mother has high blood and is taking medication for pre-term labor

📍 If the baby is not developing normally to regularly assess the condition.

SIGNS OF POSSIBLE PROBLEMS

📍 Heart rate lower than 110 and higher than 160

📍 Pattern isn't normal

📍 Heart rate doesn't speeds up when the baby moves and the uterus contracts.

FINDINGS TO REPORT IMMEDIATELY IN CHECKING THE FHR

📍 Absence of FHT

📍 Decrease in FHR that doesn't return to baseline immediately.

📍No fetal movements after 22 weeks.

LEOPOLD MANEUVER

- is a systematic palpation of the uterus using the senate of touch, its main purpose is to detect
malposition of the baby. And it also helps the maternal-fetal relationship of the baby.

- it is usually done in a place where ultrasound is not available.

- after 24 weeks ih perform.

THREE FAMOUS

1. no cost

2. Easy to perform

3. Non-invasive

FACTORS THAT AFFECT LEOPOLD MANEUVER:

1. Obese
2. Woman with full bladder

3. Woman with full hydramus (bukun ata biyaan spelling sin hydramus) too much amniotic fluid..

1ST MANEUVER- FUNDAL GRIP

- aims to determine fetal lie.

FETAL LIE

- is the relationship of the longitudinal of the mother to the longitudinal of the baby.

THREE TYPES OF LONGITUDINAL

1. Longitudinal lie

2. Transvere lie

3. Oblique lie

2ND MANEUVER-LATERAL GRIP

-aims to determine the location of fetal back.

3RD MANEUVER- SECOND PELVIC GRIP OR PAWLIK’S GRIP

3 AIMS:

1. Validate the first maneuver.

2. Identify fetal presentation.

3. Identidy engagement.

4TH MANEUVER- LEOPOLDS FIRST PELVIC GRIP

- aims to determine fetal attitude.

FETAL PRESENTATION- STEP 3

- is anatomical presentation leading closes to the pelvic grip.

TYPES;

1. Cephalic presentation

2. Breach presentation

3. Shoulder presentation

4. Oblique presentation( unidentified presentation)

TYPES OF BREACH PRESENTATION;

1. Complete breach

2. Incomplete or frac breach

3. Footling breach

TYPES OF SHOULDER PRESENTATION;

1. Arm

2. Shoulder

3. Trunk

FETAL ATTITUDE
- is the relationship of fetal head to fetal spine.

TYPES;

1. Vertex (normal)

2. Military or sinciput

3. Brow

4. Face