Leopold’s Maneuver, Fetal Heart Tone, Fundic Height Measurement

A systematic method of observation and palpation to determine the presentation, fetal position, attitude, fetal lie, and degree of engagement.

Leopold’s Maneuver

refers to the fetal anatomic part proceeding first into the pelvic inlet.

Presentation

– heads up, heads down?

Attitude

pos. based on vertebral column of mother

- Fetal lie

The process involves locating the fetus' brow.

Engagement

3 Purpose of Leopold’s Maneuver

• To determine the presentation, position and attitude of the fetus

• To estimate the fetal size

• To locate fetal parts

The first fetal body part being presented on the inlet cavity.

Fetal presentation

When the fetal head is approaching the pelvic inlet, it is referred to as

cephalic presentation

Types of cephalic presentation

vertex, sinciput, brow, and face

fetal head is partially flexed, with the anterior fontanelle, or bregma presenting

Sinciput

fetal head is partially extended; sinciput (forehead) is the presenting part

Brow

head is hyperextended; face is the presenting part.

When the fetus is in the vertex position: Head, round, hard, firm, move independently

Face

When the fetus is in the breech position, the head should feel hard, round, and movable

Breech

Types of Breech Presentation:

1. Frank

2. Footling

3. Single Footling breech

4. Double Footling Breech

5. Incomplete

6. Complete

flexed hips and extended knees (feet presenting)

Frank

hips and legs extended

Footling

hip of one leg is flexed and the knee of the other is extended (one foot presenting)

Single Footling breech

- both thighs and legs are extended (feet presenting)

Double footling breech

thighs and legs flexed (cannonball position)

Complete

Relationship of fetal parts to each other; usually flexion of head and extremities on chest and abdomen to accommodate to shape of uterine cavity

Fetal attitude

head is maximally flexed

Vertex

head is partially flexed

Military

head is maximally extende

Brow

head is partially extended

Face

the bouncing of the baby

Ballottement

(+) Ballottement, what engagement?

(-) engagement

(+) engagement, what is ballottement?

(-) ballottement

The relationship of maternal long axis and fetal long axis

Fetal lie

dependent upon degree of flexion of fetal head on chest

Vertex presentation

FLEXION OF FETAL HEAD ON CHEST:

O?

full flexion–occiput

FLEXION OF FETAL HEAD ON CHEST:

M?

full extension–chin

FLEXION OF FETAL HEAD ON CHEST:

B?

moderate extension–brow

dilate before efface

primi