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Transcript of rle leopolds
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Definition of Terms
Fundus ² Latin word for bottom. In OB, fundus is the
base of the uterus
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Symphysis pubis - The area in the front of the
pelvis where the pubic bones (the two bones of the
pubis) meet.
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FETAL ATTITUDE- describes the degree of flexion a fetus assumes during labor or
the relation of the fetal parts to each other.Suboccipito-bregmatic
(Vertex) ² good
attitude because of
complete flexion: spine
is bowed forward,
head flexed forward
so much that the chin
touches the sternum,
the arms are flexedand folded on the
chest, thighs are flexed
onto the abdomen.
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Occipitofrontal ²
moderate flexion if the
chin is not touching the
chest.
�Military position
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Brow presentation ²
partial extension
present the ´browµ of
the head
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Occipitomental ² poor
flexion, complete
extension of the head
to the birth canal
� This position occurs if
the amount of amniotic
fluid is less than normal
which does not allow
the fetus adequate
movement.
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FETAL PRESENTATION
- denotes the body part that will firstcontact the cervix or be born first.
Cephalic presentation ² the fetal head is the body
part that will first contact the cervix.
Breech presentation ² either the buttocks or the
feet are the first body parts that will contact the
cervix.
Shoulder presentation ² a fetus lie horizontally inthe pelvis. The presenting part is usually one of the
shoulder (acromion process), an iliac crest, a hand,
or an elbow
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Complete breech ²
the fetus thighs tightly
flexed on the
abdomen; both the
bottocks and the
tigthly flexed feet
present to the cervix
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Incomplete Breech
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Frank Breech
presentation ²
attitude is moderate
because the hips are
flexed but the knees
are extended to rest
on the chest. The
buttocks alone present
to the cervix.
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Footling Breech
presentation ² neither
the thighs nor the
lower legs are flexed.
If one foot is presents,
it is a single-footling
breech; if both present,
it is a double-footling
breech.
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Shoulder Presentation
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Fetal Position
Position is the relationship of the presenting part to
the specific quadrant of a woman·s pelvis
The maternal pelvis is divided into for quadrant
according to mother·s right and left
a. Right anterior
b. Left anterior
c. Right posteriord. Left anterior
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Four parts of a fetus have been chosen as landmark
to describe the relationship of the presenting part
to one of the pelvic quadrants:
a. OCCIPUT in vertex position
b. CHIN (MENTUM) in face presentation
c. SACRUM in breech presentation
d. SCAPULA or the ACROMION in shoulder presentation
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Examples:
LEFT
OCCIPUTOANTERIOR
LEFT MENTOTRANSVERSE
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LEFT
SACROPOSTERIOR
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FETAL POSITION
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EXPECTED DATE OF CONFINEMENT
NAGELE·S RULE
� To calculate the date of birth, count backward 3
calendar months from the first day of the LMP and add
7 days.
� Example:
� LMP: January 3
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What is the EDC?
LMP: April 25, 2011
LMP: January 18, 2010
LMP: June 13, 2012
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McDONALD·S RULE
A symphysis-fundal height measurement is a
common method of determining, during
midpregnancy, that a fetus is growing in utero.
The distance from the uterine fundus to the
symphysis pubis in centimeter is equal to the week
of gestation between 20th-31st weeks of pregnancy.
12 weeks AOG ² symphysis pubis 20 weeks AOG ² umbilicus
36 weeks AOG ² xiphoid process
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LEOPOLD·S MANEUVERS
Are a systematic method of observation and
palpation to determine fetal presentation and
position.
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PROCEDURES
PREPARE THE CLIENT
� Explain the procedure
� Instruct the client to empty he bladder
� Position the woman supine with knees slightly flexed.
Place a small pillow or rolled towel under one side.
�Wash your hands using warm water.
�
Observe the woman·s abdomen for longest diameterand where fetal movement is apparent.
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PERFORM THE FIRST MANEUVER
� Stand at the foot of the client, facing her and place
both hands flat on her abdomen.
� Palpate the superior surface of the fundus. Determine
the consistency, shape and mobility.
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PERFORM THE SECOND MANEUVER
� Face the client and place the palms of each hand either
side of the abdomen.
� Palpate the sides of the uterus. Hold the left hand
stationary on the left side of the uterus while right hand
palpates the opposite side of the uterus from top to
bottom. Then hold the right hand steady and repeat
palpation using the left hand on the left side.
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PERFORM THE THIRD MANEUVER
�Gently grasp the lower portion of the abdomen just
above the symphysis pubis between the thumb and the
index finger together. Determine any movement andwhatever the pat firm or soft.
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PERFORM THE FOURTH MANEUVER
� Palpate finger on the both sides of the uterus
approximately 2 inches above the inguinal ligament,
pressing downward and inward in the direction of thebirth canal. Allow fingers to be carried downward.
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