LEOPOLD’S MANEUVER (ABDOMINAL EXAMINATION) Leopold’s Maneuvers
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are a systematic method of observation and palpation to determinefetal position, presentation, lie and attitude. It is preferably performed after 24 weeks gestationwhen fetal outline can be palpated
Keen observation of abdomen should give data about: 1.longest diameter in appearance longest diameter a!is" is the length of the fetus" 2.location of apparent fetal movement the location of the activity most likely reflects theposition of the feet" I. PREPARATION 1"ARDINAL RULE 1" Instruct woman to e!p"# $ladder %&rs" comfort and #ationale: $his will promotes comfort and allows for more productive palpation because fetal contour will not be obscured by a distended bladder
2" %lace woman in dorsal re'u!$en" pos&"&on, supine with knee fle!ed #ationle: to rela a$do!&nal !us'les. %lace a small pillow under the head for comfort &"Drape properl# to maintain pr&va'# 4)Epla&n pro'edures to gain patient's cooperation ("ar! *ands o
first by rubbing them together before placing them over the woman'sabdomen woman'sabdomen to aid comfort. #ationale: )old hands may stimulate uterine contractions
*"+se the pal! %or palpa"&on no" %&n+ers "-uring the %&rs" "*ree !aneuvers, stand %a'&n+ "*e pa"&en"s or the las" !aneuver, stand %a'&n+ pa"&en"’s %ee" II. T,E -OUR MANEUVERS /I#0$ 3+5# 6 -undal .r&p/ LM0 : 7hat fetal pole or part occupies the fundus89palpation fundus89palpation of the fundal area to determine which fetal part is located in the uterine fundus9to determine the:
presen"&n+ par" or presen"a"&on part of the fetus lying over the inlet" a+e o% +es"a"&on via fundic height
Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN
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%#)-+#0 1"idwife stands at the side of the bed, facing the client 2"+sing both hands, feel for the fetal par lying in the fundus I3-I3;0 9$he midwife9midwife should ascertain what is lying at the fundus by feeling theupper abdomen fundus" with tips of both hands. ;enerally, she will find there isa mass, which will either be the head or the buttocks breech" of he fetus. $hemidwife9midwife must decide which pole of the fetus< it is by observing $hree points 1.#elative consistency 9 the head is harder6 firmer than the breech 2.0hape 9 if the head, it will be round and hard, and the transverse groove of the neck maybe felt. $he breech has no groove and usually feels more angular &.obility 9 the head will move independently of the trunk< but the breech moves only incon=unction with the body9If the midwife9midwife feels the head, the fetus is in breech presentation< if the midwife9 midwifefeels the buttocks, it means the fetus is in verte! presentation /0)3- 3+5#6 U!$&l&'al .r&p/LM1 : 7hich side is the fetal back89to locate6identify the
%e"al $a'2 in relation to the right and left sides of the mother %e"al pos&"&on the relationship of the presenting part to one of the >uadrantsof the mother's pelvis
%#)-+#0 1"$he midwife9midwife places the palmar surfaces of both hands on either side of the abdomen. 2" 7ith left palm stationary on the left side of the abdomen to steady theuterus the right palpates the right side of the uterus on a circular motionfrom top to lower segment of the uterus applying gentle but deep pressureto palpate the fetal outline and small fetal parts &"$he midwife9midwife then reverses her hands. I3-I3;0 90mall fetal parts knees and elbows" feel nodular with numerous angular nodulations9etal back feels smooth, hard, like a resistant surface /$?I#- 3+5#6 Pa3l&2’s .r&p/LM4 : 7hat fetal part lies above the pelvic inlet89determine if the
Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN
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presenting part has entered the pelvis en+a+e!en" o% presen"&n+ par""9to find the head at the pelvis and to determine the Ballo""e!en" 9 mobility of the presenting part
%#)-+#0 1" midwife stands at the side of the bed, facing the client 2"It should be conducted by gently grasping the lower portion of the abdomen, =ust above the symphisis pubis, between the thumb and the two fingers of one hand and then pressing together slightly and make gentle movements from side to side I3-I3;0 9If the presenting part moves, round, balottable and easily displaced it is not yet engaged. If the presenting part is not movable felts as relatively fi!ed,knoblike part, it is engaged.9If it is firm, it must be the head. If soft, it could be breech /+#$? 3+5# / Pelv&' .r&p/LM5 : 7hich side is the cephalic prominence8 ep*al&' pro!&nen'e
9is part of the fetal head that prevents the deep descent with one hand9to determines the degree of fetal head fle!ion or e!tension9to determine the a""&"ude or *a$&"us
de+ree o% %le&on o% "*e %e"al $od#, head and e!tremities,or the relationship of fetal parts to each other"9 to determine the
fetal descent
9should only be done if fetus is in cephalic presentation. Information about the infant's anteioposterior position may also be gained from this final maneuver %#)-+#0 1"$he midwife9midwife faces the feet of the client2"%lace one hand each on either side of the lower pole of the uterus&"%alpate the fetal head by pressing downward about 2 inches above theinguinal ligament4"+se both hands I3-I3; 9If descended deeply, only a small portion of the fetal head will be palpated.9If cephalic prominence or brow or the baby is on the same side of the smallfetal parts, the head is fle!ed9If the cephalic prominence is on the same side of the fetal back, the head is e!tended
Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN
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Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN
Page