RETURN DEMONSTRATION

PROCEDURE 1: LEOPOLD’S MANEUVER

Preparation:
1. Ask the patient to empty the bladder
2. Position the patient into a dorsal recumbent position,
with flexed knees to relax the abdominal muscles.
3. Place a small pillow under the patient’s head for its
comfort.
4. Drape properly to maintain privacy
5. Explain the procedure to the patient
6. Warms hand by rubbing together (Cold hands can
stimulate uterine contraction) Remember to use the
palm for palpation not the finger.
Position
1st Maneuver or Fundal Grip -
- Determines which part of the fetus is in the fundus - Relationship of assigned area of the presenting
- Place palms on each side of the upper abdomen and part or landmark to the maternal pelvis.
palpate around the fundus (if the head is in the fundus,
one would feel a hard, round, and moveable object)
- The buttocks will feel soft and have an irregular shape
and are more difficult to move.

2nd Maneuver or Umbilical Grip

- Move hands downward over each side of the
abdomen, applying firm even pressure
- The fetus back, which is a smooth, hard surface, should
be left on one side of the abdomen
- Irregular knobs and lumps, which may be the hands,
feet, elbows, and knees, will be felt on the opposite side
of the abdomen

3rd Maneuver or Pawlik’s Grip

- Confirms fetal postion
- Place hand above the symphysis pubis
- Bring thumb and fingers together and grasp the part of
fetus between them (may be either the head or the
buttocks)
4th Maneuver or Pelvic’s Grip
- Used in the late stage of pregnancy to determine how
far the fetus has descended into the pelvic inlet.
- Place hands on the sides of the lower abdomen, close
to the midline
- Slide hands downward and press inward
- If it has been determined that the buttocks are in the
fundus, then feel for the head
- If the head cannot be felt, it has probably descended
Presentation
- Presenting part: portion of the fetus that enters
the pelvis first
Cephalic
- The most common presentation
- The HEAD presents first
Breech
- Buttocks present first
- Delivery by caesarean section may be required,
although it is often possible to deliver vaginally
Different types of breech position
- Complete breech – parehas inot ang bitis
- Incomplete breech – inot ang sarong bitis
- Frank breech – inot ang lubot
Shoulder
- Fetus is in a transverse lie, or the arm, back,
abdomen, or side could be present
 - If the fetus does not spontaneously rotate or it
is not possible to turn the fetus manually, a
cesarean section may be performed
Engagement
- The settling of the presenting part in the pelvic
brim
- The sensation that a pregnant woman feels
when the lowermost part of the fetus descends
and is engaged in the mother’s pelvis, an event
that typically occurs 2 to 3 weeks before labor
begins.
Lie
- the relationship of the spine of the fetus to the
spine of the mother.
Longitudal/vertical
- Fetal spine is parallel to the mother’s spine
- Fetus is either cephalic or breech presentation
Transverse
- Fetal spine is at right angle, or perpendicular to
the mother’s spine
- Presenting part is the shoulder
Oblique
- Fetal spine is at a right angle from a true
horizontal lie
- Delivery by ceasarian section if uncorrected
Station
- The measurement of the progress of descent is
centimeters above or below the midplane from
the presenting part to the ischial spine
- Station 0: at ischial spine
- Minus station: above ischial spine
- Plus station: below ischial spine
- 3. Screen the mother’s bed to maintain privacy.
Measuring FUNDAL HEIGHT
- place the zero line of the tape measure on the
anterior border of the symphysis pubis and
stretch tape over midline of abdomen to top of
fundus.
- The tape should be brought over the curve of
the fundus
- The height of the fundus in centimetre equal to
the number of weeks gestation plus or minus 2
- After 32 weeks the relationship is less accurate
- Perform leopold’s manuever
Perineal flushing
- Cleaning the patient’s external genitalia and
surrounding skin using antiseptic solution.
Purposes:
1. To cleanse the perineal skin
2. To reduce chance of infection of episiotomy
wound and promote healing of suture line
3. To stimulate circulation
4. To reduce body odor and improve self-image
5. To promote the feeling of well-being
6. To maintain cleanliness and comfort
Equipment:
1. Clean tray containing:
- Sterile antiseptic lotion
- Sterile normal saline in a bottle
- Ovum forceps / pickup forceps
- Antiseptic or betadine
- Sterile sanitary pad
- Kidney tray
- Sterile tray
- Sterile gloves.
- Draping sheets / rubber sheet
2. Sterile pack or tray containing
- Forcep
- Pick-up forcep
- Cotton balls
- Gauze balls
- Sterile towel to wipe hands after surgical scrub
Procedure:
1. Identify the patient, explain the procedure to the
mother, the purpose and how she has to cooperate.
2. Prepare the Equipment and Take to bedside. To save
time and effort.
4. Close the window to maintain warm and also to
provide privacy as well
5. Wash hands and wear gloves. To minimize the
infection
6. Position the mother in Dorsal Recumbent Position.
This position provides easy access to genitalia.
7. Place rubber sheet under the mother’s hip. To
minimize the transmission of the microorganism.
8. Remove soiled pad or adult diaper from front to back.
To minimize the spread of the microorganism.
9. Observe color and amount and odor of discharge. To
detect any abnormalities.
10. Wrap soiled pad and throw it in a paper bag. To
minimize the infection.
11. Test the temperature of the antiseptic solution. To
Prevent burns to perineum.
12. Use antiseptic solution for cleansing.

In cleansing,
A. Clean the mons pubis from the level of clitoris
upward to the lower abdomen in a zigzag line.
B. Clean two thighs from medial (inner) to lateral (outer)
in a zigzag line.
C. Clean two labia majora from upward to downward in
a single motion.
D. Clean the introitus from upward to downward in a
single motion.

- The cleansing method reduces the transfer of

microorganism to the urinary meatus.

INTERNAL EXAMINATION
- It is the examination done per vagina to detect
the status of the vagina and cervix, and to
assess the progress of labor as the fetal
presenting part descent through the birth canal.
1. DILATATION (cm) – pag bukas ng cervix
2. EFFACEMENT (%) – pag nipis ng cervix
Purposes
- To make a positive diagnosis of pregnancy
- To monitor cervical dilatation and effacement
- To make a positive identification of the fetal
presentation, position, station
- To assess status of head (flexion or extenstion)
And degree of moulding presence of fetal skull
swelling
- To ascertain whether the membranes have
ruptured or not
- To determine if cord prolapsed is likely to occur
- To assess the progress or delay in labor
- To detect whether second stage has begun
- To apply fetal scalp electrode.
Equipment
- Sterile tray containing
1. Sterile cotton balls to give perineal care
2. Artery clamp
3. Bowl w/ antiseptic solution
4. Sim’s vaginal speculum
5. Sterile cream in a bowl for lubricant
6. Sterile gloves (outside the tray)
General instruction
- the bladder should be empty
- the fingers should not be withdrawn until the
required information has been obtained
- perineal care should be given before performing
vaginal examination
- it should be restricted or limited after
membranes have ruptured