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Leopards Maneuver

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31 views3 pages

Leopards Maneuver

Uploaded by

queenpaxton
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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MEASURING FUNDIGHT.

Measuring of fundic ht.

McDonalds Rule
- by measuring the height from the symphysis pubis to the fundus(in cm.)
● Height of fundus in cm x 2/7 = AOG in months
● Height of fundus in am × 8/7 = AOG in week

Bartholomew's Rule
a by the relative position of the uterus in the abdominal cavity

TAKING FHT (FETAL HEART TONE)


● A fetoscope (a type of stethoscope) is the most basic type of external monitor.
● It works much like a regular stethoscope except that it has a bell shaped end that
magnifies sound waves from the fetal heart beat in order to make them audible.
● A structurally modified device which can amplify the fetal heartbeat in the 20th week of
pregnancy and beyond.

Doppler
A Doppler FHR monitor is a handheld ultrasound transducer used to detect the fetal heart beat
during prenatal care. This device uses the Doppler effect to provide an audible simulation of the
heartbeat. The use of this monitor is sometimes known as Doppler auscultation.

After around five and a half to six weeks gestation, a vaginal ultrasound can pick up a baby's
heartbeat. A few weeks later, at 10 to 12 weeks into pregnancy, a handheld ultrasound device
known as a fetal Doppler can be used to hear a baby's heartbeat.

The heart rate is checked at set times during labour. For example, in a pregnancy with no
problems, the baby's heartbeat might be checked every 15 to 30 minutes during the first stage
of labour. Then it would be checked more often during the second stage.

LOCATION WHERE TO PLACE THE DEVICE


The back will have been located during lateral palpation.

After establishing the baseline rate, the FHR is auscultated for 15 to 60 seconds at
recommended intervals between contractions and when the fetus is not moving to assess the
baseline rate.

An ultrasound may give you better results. A fetal heart rate is between 120 and 160 beats per
minute and can vary by five to 25 beats per minute. The baby's heart rate can change based on
conditions of uterus.

FETAL HEART TONES


https://globalhealthmedia.org/ videos/listening-to-the-babys-heart-during-labor/
LEOPOLD'S MANEUVER
m It is a common and systematic way to determine the position of a fetus inside the woman's
uterus It is preferably performed after 24 weeks of gestation when fetal outline can already be
palpated.

4 way's to estimate:
1. fetal size
2. Locate fetal parts
3. determine presentation, position,
4. engagement and attitude

Preparation
1. Explain the procedure to the women
2. Ask to void
3. Position in dorsal recumbent with knees slightly
4. flexed to better relax abdominal muscle
5. Drape properly to provide privacy
6. Warm hands

POINTS TO REMEMBER:
• Palpate with warm hands; cold hands cause abdominal muscle to contract.
• Use palm and not fingers ( it may tickle the patient)
• Palpate gently but in firm motion.

First Maneuver (Fundal Grip)


1.palpate fundus; identify parts occupying the fundus
2.determines PRESENTATION
Note: A hard smooth, ballotable mass of the fundus means the presentation is breech.

Second Maneuver (Umbilical Grip)


1. palpate sides of abdomen; locate fetal back and small parts
2. determines fetal POSITION

Third maneuver (Pawlik's Grip)


1. grasp the area above the symphysis pubis to determine presentation
2. Determine ENGAGEMENT

Fourth maneuver (PELVIC GRIP)


1. facing the mother lower extremities,
2. palpate parts above symphysis;
3. determine degree of engagement ATTITUDE

ASSESSMENT OF PREGNANT MOTHER


Leopold's Maneuver
• It is a systematic abdominal palpation to determine the position and presentation of the fetus. It
is preferably performed after 24 weeks of gestation when fetal outline can already be palpated.
• The purpose is to determine the presentation, the presenting part where it will exactly lie and
the degree of descent, and to estimate the size and number of fetus.
• Upon doing the Leopold's maneuver, we need to remember, that we need to palpate with warm
hands because cold hands cause abdominal muscles to contract
• We need also to use palms and not fingertips because it may tickle the client.
• Lastly, palpate gently but in firm motion. The patient should empty her bladder before the
procedure. The patient should lie flat on her back with knees flexed slightly to relax the
abdominal muscles. (dorsal recumbent position).

● First Maneuver (Fundal Grip)


1. (Fundal Grip), the nurse will be facing the head part. Using both hands, feel for the fetal part
lying in the fundus. You should palpate that the head is more firm, hard, and round that moves
independently of the body. Breech is less well-defined that moving only in conjunction with the
body.

● Second Maneuver (Umbilical grip)


2. The nurse's one hand is used to steady the uterus on one side of the abdomen while the
other hand moves slightly on a circular motion from top to the lower segment of the uterus to
feel for the fetal back and small fetal parts. Use gentle but deep pressure. Findings should be
that the fetal back is smooth, hard, and resistant surface. Knees and elbows of fetus feel with
several angular nodulations.

● Third Maneuver (Pawlick's Grip)


3. Using thumb and finger, grasp the lower portion of the abdomen above the symphysis pubis,
press in slightly and make gentle movements from side to side.
Findings should be: if head is engaged, it will not move and if it is not yet engaged it is still
movable.
One hand applies pressure on the fundus while the index finger and thumb of the other hand
palpate the presenting part to confirm presentation and engagement.

● Fourth Maneuver
4. Fourth Maneuver, the nurse will be face at the foot part of the client, palpate fetal head
pressing downward about 2 inches above the inguinal ligament and use both hands. Findings
should be good attitude if brow corresponds to the side (2nd maneuver) that contains the
elbows and knees; and poor attitude if examining fingers will meet an obstruction on the same
side as fetal back (hyperextend head). Also, palpate infant's anteroposterior position. If brow is
very easily palpated, fetus is at posterior position (occiput pointing towards woman's back).

The area above the symphysis pubis is palpated to locate the fetal presenting part and thus
determine how far the fetus has descended and whether the fetus is engaged. If hands are
converging; it indicates disengagement and diverging indicates engagement of the head.

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