FUNDAL HEIGHT
Fundal Height (McDonald’s rule)
• A fundal height Is a measure of the size
of the uterus during pregnancy.
• It is measured from the top of the
mother’s symphysis pubis to the top of the
mother’s uterus.
• It is expressed in centimeters which
roughly corresponds to the gestational age
in weeks between 20 to 36 weeks, w/ a
normal variance of +2/-2 centimeters.
• A tape measure is used as the medium in
measuring the fundal height .
Purpose:
• To assess the fetal growth and
development during pregnancy.
The 3 Landmarks:
1.Symphysis Pubis
- It is found on the anterior side of the pelvis and
is the anterior boundary of the perineum.
- The corresponding gestational age for this
landmark is 12 weeks of gestation.
2.Umbilicus or Navel
- It is a depression in the center of the surface of
the abdomen indicating the point of attachment of
the umbilical cord to the embryo.
- The corresponding gestational age for this
landmark is 20 weeks of gestation.
3.Xiphoid Process or the breastbone
- is a small, triangular part of the sternum. It
serves as muscular attachment point for other
muscles that make up the diaphragm.
- The corresponding gestational age for this
landmark is 36 weeks of gestation.
Fundal Height DURING Pregnancy
• During 12 weeks of pregnancy the fundal
height should be ABOVE the symphysis
pubis.
• During 20 weeks of pregnancy the fundal
height should be on the
umbilicus/navel/belly button.
• After 20-36 weeks of pregnancy fundal
height will reflect weeks of pregnancy (+)
or (-) 2 cm.
• During 36 weeks of pregnancy fundal
height will be at the xiphoid process.
• During 37-40 weeks of pregnancy the
fundal height will move down about 4cm
this is called Lightening.
Fundal Height AFTER Pregnancy
• 1 hour after birth the fundal height should
be at the belly button.
• The fundal height will decrease 1 cm per
day.
• 24 hours after birth is = 1 cm below the
belly button.
• 48 hours after birth is – 2 cm below the
belly button.
• 7 days after birth the fundal height should
be at the symphysis pubis.
• 10 -14 days after birth the fundus should
be at the pelvic cavity. It won’t be palpable
anymore.
• 6 weeks after birth the uterus should be
back at its pre-pregnancy size.
PROCEDURE:
1.Prepare the necessary things needed: tape
measure, pair of clean gloves.
2. Identify . Explain, and let the patient void
before starting the procedure.
3. Wash hands and wear gloves.
4. Place the patient in supine position , provide
privacy and expose the abdomen.
5. Palpate the abdomen until you feel the fundus
of the uterus under the skin.
6. Measure from the top of the symphysis pubis
to the top of the uterus.
7. Remove your gloves, do hand washing &
record it in the patient file.

LEOPOLD’S MANEUVER
 Leopold’s Maneuver
 is a systematic way to determine the
position of a fetus inside the woman’s
uterus.
 Named after the Gynecologist
CHRISTIAN GERHARD LEOPOLD.
 Maneuver is preferably performed
after 24 weeks age of gestation.
 The maneuvers are not truly diagnostic
 Actual position can only be determined
by ultrasound..
PURPOSE:
1. To determine the position and
presentation of the fetus.

FACTORS AFFECTING THE

PERFORMANCE OF THE
MANEUVERS.
1. Obese women
2. Hydramnios
 3. full bladder b. Palpate the side of the uterus, Hold the
left hand stationary on the left side of the
uterus while the other hand palpates the
PROCEDURE: opposite side of the uterus from top to
bottom. Repeat palpation using the left
1. Prepare the patient. hand on the left side .
a. Explain the procedure.
b. Instruct the patient to empty her bladder.
c. Position the patient supine with knees slightly
flexed.
d. Wash your hands using warm water.
e. Observe the patient abdomen for the longest
diameter and where fetal movement is apparent SECOND MANEUVER
Where is the fetal back?
 The fetal back is firm and smooth,
hard, resistant surface
 Fetal extremities- small irregularities
2. Perform the first maneuver. & protrusions.
a. Stand at the foot of the patient, facing her, place
both hands on her abdomen.
b. Palpate the superior surface of the fundus,
determine consistency , shape and mobility.
- head is firm, round, hard.
buttocks feels softer, symmetric & has small
body prominences
FIRST MANEUVER
What lies the fundus?

4. Perform the THIRD MANEUVER

a. Gently grasps the lower portion of the abdomen
just above the symphysis pubis with the thumb
and index fingers & try to press the thumb &
finger together
b. Determine what fetal part is lying above the
inlet or lower abdomen.
THIRD MANEUVER
3. Perform the Second Maneuver.
What occupies the inlet?
a. Face the patient and place the palms of
each hand on either side of the abdomen.
 FETAL HEART RATE MONITORING
FETAL HEART MONITORING
 Fetal Heart Monitoring is a medical
procedure used to monitor the heart rate of
5. Perform the FOURTH MANEUVER a developing fetus (unborn baby) during
a. Facing the foot part of the patient ,Move pregnancy & labor.
your fingers down the sides of the uterus  Normal range of FHB – 110 to 160bpm
towards the pubis to:
PURPOSE:
- locate the fetal brow.
- To assess the wellbeing of the fetus.
- determine the degree of flexion of the
fetal head - To detect any potential signs of distress or
complications
Fetal heart monitoring involves two primary
methods:
1. External fetal monitoring
 - is a non-invasive approach that
involves placing sensors ( transducer) on
the mother’s abdomen to check the FHR.
Equipment’s used:
a. Ultrasound/Portable fetal Doppler
b. Fetoscope/Stethoscope

Fetal Attitude/position
Good attitude
-If the brow correspond to the side that
contained the elbows and knees
POOR ATTITUDE
Poor attitude
-If the examining fingers will meet an
obstruction on the same side as fetal back

b.Fetoscope /Stethoscope
- used to listen to the fetal heartbeat starting as
early as the 20th week of pregnancy.
2. Internal fetal heart rate monitoring /spiral
or scalp electrode.
- involves placing an electrode directly on the
fetal scalp through the cervix.
- a wire electrode is attached to the fetal scalp or
other body part through the cervical opening and
is connected to the monitor.
PROCEDURE: ( Portable fetal Doppler)
-Things needed: clean gloves portable fetal
Doppler + ultrasound gel, tissue wipes.
1. Identify, explain, & expose the patient
abdomen.
2. Place a gel on the end of the probe (fetal
Doppler).
3. Place the transducer on the mother’s
abdomen over the area where the FHB is
best heard.
4. Wipe off the excess gel over the patient
abdomen .
5. Record the FHB in the patient file.
PROCEDURE: ( Using a Stethoscope)
-Things needed: clean gloves,
stethoscope + a watch w/ second hand.
1. Identify,explain & expose the patient
abdomen.
2. Place the stethoscope on the mother’s
abdomen over the area where the fetal
back is located.
3. Count the the FHB in one full
minute.
4. Record the FHR in the patient file.