CANOSSA COLLEGE

College of Nursing

A Self Learning Module on Related Learning Experience

Focus: In Obstetrical - Out Patient Department, OB-Clinic, Lying- in and Barangay Health Center
are specialized areas for reproductive female client, pregnant women and couple who are
planning to use family planning method.

MODULE 5

Course Code: NCM 107

Level Offering: 1st Semester, AY 2021 -2022
Clinical Area of Assignment: Obstetric Out-Patient Department/Clinic,
Lying-in and Barangay Health Center
Date: September 30-October 1-2, 2021 (Thursday, Friday, Saturday) at 2:00 pm to 9:00 pm

Module Overview:

This module is designed to develop your competencies in performing Leopold’s Maneuver.

Leopold’s Maneuver is a systematic abdominal palpation which are done to determine the position and
presentation of the fetus. And as well as, to auscultate the fetal heart tone. The nursing student must
bear in mind that he/she is taking care two individuals: the mother and her fetus. Fetal well-being or
fetal health is best measured by evaluating the Fetal heart tones.

The related learning experience will be catered to flexible clinical learning experiences through
this self-instructed module.

In addition, this learning activity might not be a substitute for actual clinical experience due to
Covid-19 pandemic. However, this will help you to direct through your nursing practice in providing
nursing care to your patient in the virtual platform. This module has the following RLE learning process:

Desired Learning Outcome: at the end of an 8-hour virtual learning exposure, you are expected to:

1. Define Leopold’s Maneuver and Fetal heart tone.

2. Discuss the purpose of Leopold’s Maneuver and Fetal heart tone.
3. Demonstrate the ability in observing and palpating the abdomen systematically to
determine fetal presentation and position, lie and attitude; estimate fetal size and locate
fetal parts.
4. Demonstrate the ability to count and assess the fetal heart tone using a stethoscope, a
fetoscope and/or Doppler.
5. Make a nursing care plan for pregnant mother and her fetus/es.
A. Pre-natal Care (Leopold’s Maneuver)
Introduction:
When a woman visits a health care facility for the first prenatal visit, an assertive effort
should be made by the nurse validate the pregnancy, determine the woman’s health status,
and initiate strategies that will encourage the woman and her family to establish positive
behavior patterns of health promotion during pregnancy and throughout their lives. This allows
a student to review the anatomic structures of the female body and demonstrate knowledge on
how to appropriately intervene to provide nursing care, education, and guidance from the visit
throughout the mother’s pregnancy. A case study is included to help the student integrate
therapeutic communication skills through Comprehensive Obstetric Health History taking and
nursing actions when assisting the patient with her first visit that include demonstrating of skills
like measuring Fundic height, checking Fetal heart tone, palpating the abdomen by means of
Leopold’s maneuver.

Let’s study the Prenatal Care: Leopold’s Maneuver

LEOPOLD’S MANEUVER

Leopold’s maneuver is a systematic method of observation and palpation of the abdomen to

determine fetal presentation and position and performed after 24 weeks.

Has 4 Maneuvers
 First maneuver or Fundal Grip
 Second maneuver or Umbilical Grip
 Third maneuver or Pawlik’s Grip
 Fourth maneuver or Pelvic Grip
FETAL PRESENTATION
 Part of the fetus that enters maternal pelvis
1. Cephalic
 Vertex (occiput)–head acutely flex
 Sinciput – head moderate flex
 Brow – head moderate extended
 Face – head acutely extended
 Mentum – chin hyperextended
2. Breech
o Sacrum – buttocks
a. Complete (full)
b. Incomplete (Frank)
c. Footling (single footling or double footling)

A. B. C.

3. Scapula – shoulder

FETAL LIE
Relationship of the fetal spine to the maternal spine:
1. PARALLEL or longitudinal
2. Right angle or transverse
 3. Angle off or oblique

FETAL POSITION

Refers to the relationship of the denominator or landmark of the presenting part to the
mother’s pelvis.

 Standard landmarks for the fetal presenting part.

 A 3-letter abbreviations is used to describe the relationship of the presenting part to
the maternal pelvis
 1. identify which side the presenting part is facing in the pelvis:
R (right)
L (left)
 2. Identify the landmark that is presenting:
O – occiput or head
S – sacrum or buttocks
Sc – scapula or shoulder
M – mentum or chin
 3. identify the direction the presenting part is facing in the pelvis:
A – anterior
P – posterior
T – transverse
FETAL ATTITUDE

Relationship of the parts to each other.

Definition

Leopold’s Maneuver is the abdominal palpation of pregnant women performed after 24

weeks gestation when fetal outline can be palpated.
Purpose

 To determine presentation, position, lie and attitude

 Estimate fetal size
 Locate fetal parts

Procedure

ACTION RATIONALE
A. Preparatory Phase
1. Explain the procedure to the client. Promotes cooperation

2. Ask the client to empty her bladder.
3. Wash hands and observe other appropriate
infection control procedures. .
4. Prepare client.
Place client in in dorsal recumbent position
(knee slightly flex). Place small pillow under
the head.
5. Ask the client to bare her abdomen from the To ensure the accuracy of the
lower rib margin to the pubic bone.
6. Drape appropriately.
7. Warm your hands first by rubbing them
together before placing over the pregnant
woman’s abdomen.
8. Observe the woman’s abdomen for longest To aid in locating the FHT
diameter and where fetal movement is
apparent.
B. Performance Phase
Promotes comfort and aids in the
performance of the procedure.
Reduces transmission of
microorganism.
Position relaxes the abdominal
muscles.
measurement.
Promotes comfort and aids in the
performance of the procedure
Maintain client’s privacy.
Cold hands may stimulate
abdominal muscles to contract.

First Maneuver (Fundal Grip)

9. Face the head part of the client. To determine the fetal

presentation or the part of the
fetus (fetal head or breech).
10. While facing the woman, place the hands
 on the top of the uterus (fundus) and
palpate.
 Head feels smooth, hard/firm and
round, freely movable and
ballotable.
 A breech feels irregular, rounded,
softer and is less mobile.

Second Maneuver (Umbilical Grip)

11. Still facing the woman, put both hands on To determine the fetal position or
either side of the abdomen, applying gentle identify the relationship of the fetal
but deep pressure. back and the small parts to the
 The back is long, smooth and a hard, front, back or sides of the maternal
continuous structure; fetal body pelvis
parts (extremities) will feel knobby,
irregular and may be moving.
12. Place hand stabilizes the one side of the
uterus, the other hand palpates the
opposite side to identify the location of the
back and small parts. Palpation begins in the
midline and continues down the side of the
uterus. The other side of the uterus is
stabilized and palpated. Palpate, applying
gentle but deep pressure.
13. Repeat the same procedure on the opposite To identify fetal parts correctly.
side.
Third Maneuver (Pawlik’s Grip)

14. While facing the woman, grasp the lower To determine the engagement
uterine segment between the thumb and portion of the fetus that is
fingers of one hand just above the presenting.
symphysis pubis.

15. Press in slightly, using thumb and finger and
make gentle movements from side to side.
 Pay close attention to the size,
contour and consistency of the
presenting part.
 The head will feel firm and globular.
 If immobile, engagement has
occurred.
 The head is the inlet or in the pelvis
 in 90% of women.
16. Determine any movement and whether the
part is soft or firm.
17. Identify correctly the presenting part.
Fourth Maneuver (Pelvic Grip)

18. Face the client’s foot part, place palm on the To determines degree of flexion of
sides of the abdomen, just above the the fetal head
inguinal ligament.
19. Grasp snugly the lower abdomen and with
the outstretched thumbs, meeting at the
umbilical level.
 A small portion of the fetal head can
be palpated if it descends deeply.
 If cephalic prominence or brow of
the baby is on the same side of the
small fetal parts, the head is flexed.
 If cephalic head is prominence is on
the same side of the fetal back, the
head is extended.
20. Identify correctly the degree of flexion,
position and station of the presenting part.
21. Make no unnecessary exposure of client’s
body and return to position
22. Explain the findings to the woman. To promote participation in care
and understanding of the status.
23. Wash hands. Reduces transmission of
microorganism.
24. Document the results. To serve as baseline data for health
care provider.

Reference:
1. Pilliteri, Adele, (2010). Maternal and child Health Nursing: Care of the Childbearing and
Child Rearing Family (6th ed). Philadelphia: Lippincott Williams and Wilkins.
2. https://www.youtube.com/watch?v=5K-ERuVrvj4
Learning Task 1: Preliminary questions about Leopold’s Maneuver

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your
responses should be detailed and direct to the point. When asked to provide several
answers, list them in order of priority or significance.
2. Please submit on or before September 30, 2021 thru Google Classroom
A. Identification.
1) ________________________ A nursing procedure that palpates the abdomen of the
pregnant woman to assess the position, presentation, lie and size after 24 weeks AOG.
2) ________________________ The 4 Maneuver of Leopold’s maneuver. (Answer from
nos. 2-5).
3) ________________________
4) ________________________
5) ________________________
6) ________________________ What maneuver that assess the fetal lie?
7) ________________________ This maneuver determines the fetal presentation.
8) ________________________ Best position of the patient to assess the abdomen.
9) ________________________ What is the reason, wherein the nurse should rub her
hands before
palpating the abdomen.
10) ________________________ Why is it necessary for the patient to empty her bladder
before the
procedure.
11) ________________________ The only maneuver that uses only one hand.

Learning Task 2: Case Study/Nursing Care Plan

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your
responses should be detailed and direct to the point. When asked to provide several
answers, list them in order of priority or significance.
 2. Please submit on or before _______, 2021 thru Google Classroom.
Case Study:
Read the scenario:
Maine revisits to the clinic at 9 weeks of pregnancy. She has dry, cracked lips, and with a
cardiac rate of 92 bpm. She states that she is experiencing nausea with frequent vomiting all
day. She reports that the nausea is aggravated by the odor of sautéed garlic and has little
appetite. Even though she is always thirsty, she restricts drinking of water because “it makes
me sicker.” Her urinalysis result is concentrated, with a specific gravity of 1.02.
Nursing Care Plan:
Fill in the appropriate elements of the care plan for this client.

NURSING PLANNING
ASSESSMENT DIAGNOSIS GOAL / NURSING RATIONALE EVALUATIO
DESIRED INTERVENTIONS N
OUTCOME
Learning Task 3: Develop the nursing skills in demonstrating accurate Leopold’s Maneuver

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your
responses should be detailed and direct to the point. When asked to provide several
answers, list them in order of priority or significance.
2. Please submit on or before October_______, 2021 thru Google Classroom.
You are now duty in the OB – Out-Patient Department of LPH-SPCDH. In this 24-hour duty, you
are expected to perform and Leopold’s Maneuver to pregnant woman. Use the checklist for
below for your return demonstration via video presentation and send via LMS. Be sure you are
wearing your clinical uniform and use the suggested supply and equipment. Your focus on the
following:
 Therapeutic Communication Technique
 History Taking
 Aseptic technique
 Providing Privacy/Confidentiality
 Computations of EDD and AOG
 Health teaching
 Documentation of Data

CANOSSA COLLEGE
College of Nursing
San Pablo City

SKILLS CHECKLIST FOR NURSING CARE MANAGEMENT 107

1st semester, 2021-2022

Student Name:
Score:
Clinical Instructor:
Date:

Checklist: Leopold’s Maneuver

Rubrics:
3 – the student was able to perform the procedures correctly based on standards
2 – the student was able to perform the procedures but needs improvement in some areas
1 –the student was not able to perform the procedure correctly because of unpreparedness showing
nervousness
Objective:

 Demonstrate the ability in observing and palpating the abdomen systematically to

determine fetal presentation and position, lie and attitude; estimate fetal size and locate
fetal parts.

Implementation 1 2 3 Remarks
Performance
1. Assess:
 The previous clinic visits.
 Retrieve the record if old patient.
 The Last menstrual period (LMP) and AOG.
2. Assemble equipment and supplies:
Draping sheet
Procedure
1. Explain to the client what you are going to do,
why it is necessary, and how she can
cooperate.
2. Wash hands and observe other appropriate
infection control procedures.
3. Ask the client to empty her bladder.
4. Prepare the client.
 Assist the client in supine position (knee
slightly flexed). Place small pillow under
the head and small pillow or rolled towel
under the knee
5. Ask the client to bare her abdomen from the
lower rib margin to the pubic bone.
6. Drape appropriately.
7. Warm your hands first by rubbing them
together before placing over the pregnant
woman’s abdomen.
8. Observe the woman’s abdomen for longest
diameter and where fetal movement is
apparent.
Palpation 1 2 3 Remarks
Performance Phase

First Maneuver (Fundal Grip)

9. Face the head part of the client.
10. While facing the woman, place the hands on
the top of the uterus (fundus) and palpate.
11. Palpate the superior surface of the fundus.
 Determine consistency, shape, and mobility.

Second Maneuver (Umbilical Grip)

12. Still facing the woman, put both hands on

either side of the abdomen, applying gentle
but deep pressure.
13. Place hand stabilizes the one side of the
uterus, the other hand palpates the opposite
side to identify the location of the back and
small parts down. Palpation begins in the
midline and continues the side of the uterus.
The other side of the uterus is stabilized and
palpated. Palpate, applying gentle but deep
pressure.
14. Repeat the same procedure on the opposite
side.
Third Maneuver (Pawlik’s Grip)

15. While facing the woman, grasp the lower uterine

segment between the thumb and fingers of one
hand just above the symphysis pubis.
16. Press in slightly, using thumb and finger and
make gentle movements from side to side. Pay
close attention to the size, contour, and
consistency of the presenting part.
17. Determine any movement and whether the
part is soft or firm.
18. Identify correctly the presenting part.
Fourth Maneuver (Pelvic Grip)

19. Face the client’s foot part, place palm on the

sides of the abdomen, just above the inguinal
ligament.
20. Grasp snugly the lower abdomen and with the
outstretched thumb, meeting at the umbilical
level. Place the fingers on both sides of uterus
approximately 2 inches above the inguinal
ligaments, pressing downward and inward in
the direction of the birth canal.
21. Identify correctly, the degree of flexion,
position, and station of the presenting part.
22. Make no unnecessary exposure of client’s
body and return to position.
 23. Explain the findings to the woman.
24. Wash hands.
25. Document the results.

Remarks
Preparation – able to
gather the instruments and
able to consider safety of
the patient, able to discuss
to the patient information
prior to the performance of
the procedure) 15%
Knowledge (able to answer
questions that may be
asked by the Clinical
Instructor 15%
Performance based on the
checklist guideline (50%)
Professionalism -the
conduct of performing the
procedure (20%)

Total Grade

Evaluator:
______________________________________________
Clinical Instructor

Let’s study the Prenatal Care: Fetal Heart Tone

B. Fetal Heart Tone

Introduction:
When a woman visits a health care facility for the first prenatal visit, an assertive effort
should be made by the nurse validate the pregnancy, determine the woman’s health status and
initiate strategies that will encourage the woman and her family to establish positive behavior
patterns of health promotion during pregnancy and throughout their lives. This allows a student
to review the anatomic structures of the female body and demonstrate knowledge on how to
appropriately intervene to provide nursing care, education, and guidance from the visit
throughout the mother’s pregnancy. A case study is included to help the student integrate
therapeutic communication skills through Comprehensive Obstetric Health History taking and
nursing actions when assisting the patient with her first visit that include demonstrating of skills
like measuring Fundic height, checking Fetal heart tone, palpating the abdomen by means of
Leopold’s maneuver.

Let’s first review your background of Assessing Fetal and Maternal Health: Prenatal Care
Assessing Fetal Heart Tone

Fetal heart tone (FHT) also referred to as fetal heart rate (FHR) are auscultated with a De
Lee-Hillis fetoscope or Pinard stethoscope. However, in the practice, the term auscultation is
often used to refer to the assessment of the fetal heart sounds by means of a hand-held
Doppler device or ultrasound monitor.

The ultrasonic Doppler device is the primary tool for assessing fetal heartbeat. It may detect
fetal heartbeat at about 10 to 12 weeks’ gestation. The normal range for fetal heart tones (FHT)
is 120–160 beats per minute (bpm). An ultrasound should be completed if the nurse is unable
to auscultate between 10 and 12 weeks, because there may be a discrepancy of EDD, twins, or
a missed abortion. In the case of twins or the obese woman, it may be later before the fetal
heartbeat can be detected.

Pinard Fetoscope

Doppler Device
Stethoscope
 FHT Locations on The Abdominal Wall indicating possible
Fetoscope
corresponding fetal positions and Using The 4 Quadrants

Definition:
 This is a method of listening to the fetal heart tone periodically or intermittently to
measures the heart rate and rhythm of fetus.

Purpose:
 To evaluate fetal well-being through auscultation of the fetal heart rate to determine
the rate and rhythm.

Equipment:
 A stethoscope, a fetoscope and/or Doppler.
 Watch or clock with a second hand
 Water-base lubricant or KY Jelly
 Draping sheet

PROCEDURE RATIONALE
1. Explain to the client what you are going to do,  To ensure correct procedure to
why it is necessary, and how she can cooperate. right patient.
 Explaining procedure reduces
anxiety and fear thus promoting
cooperation from the client.
 To ensure correct procedure to
right patient.
2. Wash hands and observe other appropriate  Reduces transmission of
infection control procedures. microorganisms.
3. Ask the client to empty her bladder.  To ensure the accuracy of the
 measurement.
 Promotes comfort and aids in
the performance of the
procedure.
4. Prepare the client.
5. Assist the client to lie down in bed.
6. Ask the client to bare her abdomen from the
lower rib margin to the pubic bone.
7. Drape appropriately.
8. Stand at the woman’s side by palpation,
determine the following:
a. Fetal position
b. Fetal presentation
c. Fetal lie
d. Fetal attitude
9. Place the head of the stethoscope using the bell
side on the abdomen over the back (or chest) of
the fetus. or
Apply Lubricant gel on the transducer of the
Doppler and place on the abdomen over the
back or chest of fetus.
10. Palpate the maternal radial pulse to
differentiate the maternal heart rate from FHT.
11. Do the following:
a. Listen and count the beats for one full
minute
b. Listen with an interval for 2-5 minutes for at
least twice or five times.
c. Compare counts to determine variability.
12. Assess for variability of the fetal heart rate:
a. As it occurs spontaneously, and/or
b. As it occurs with fetal activity, and/or
c. As it occurs with palpation of the fetus
d. Note irregularity of heart rate or heart
sounds
e. Any increases or decreases in the FHR.
f. Loudness of the heart tones relative to the
position of the fetus.
13. If the location of the fetal heart tones conflicts
with your assessment of #8 above, repeat # 8 to
be sure of the fetal position, if necessary.
14. Explain the findings to the woman.
15. Clean the Stethoscope with cotton swab or ball
and alcohol
 To ensure safety
 Promotes comfort and aids in
the performance of the
procedure.
 Maintain client’s privacy.
 To locate properly the fundus.
 To ease the procedure
 Ideal position to best hear the
fetal heart tone
 To auscultate properly and
clearly.
 Avoid friction noises caused by
fingers on the abdominal
surface area.
 To identify accurately the
correct fetal heart sound.
 Provides proper monitoring of
the FHT.
 To assess properly if there is any
deviation.
 To ensure correct location of the
FHT.
 To promote participation in care
and understanding of the status.
 Ensures comfort for the client.
Although always clean
 Or equipment between client to
Clean the transducer and the mother’s prevent transfer of
abdomen with clean tissue microorganisms.
16. Wash hands.  To reduce transfer of
microorganisms.
17. Document the results.  To provide accurate record of
data needed for further care or
treatment.
 To serve as baseline data for
health care provider.

Reference:
1. Pilliteri, Adele, (2010). Maternal and child Health Nursing: Care of the Childbearing and
Child Rearing Family (6th ed). Philadelphia: Lippincott Williams and Wilkins.
2. https://www.youtube.com/watch?v=BWiLPGErVF0
3. https://youtu.be/jFWUYfuvUkQ
4. https://youtu.be/AuUzJH1ssIA
5. https://youtu.be/4YlVvP5Z4XM
6. https://nurseslabs.com/prenatal-visit/
7. https://www.youtube.com/watch?v=p6Ma0D-fN38
8. http://www.ofeverymoment.com/2014/09/how-many-days-are-in-this-month.html
9. https://nurseslabs.com/physiological-changes-pregnancy/
10. https://nurseslabs.com/fetal-development/

Learning Task 1: Review of Leopold’s Maneuver and Fetal Heart Tone

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your
responses should be detailed and direct to the point. When asked to provide several
answers, list them in order of priority or significance.
2. Please submit on or before October_______, 2021 thru Google Classroom.
A. Identification.
1) ______________________ Normal fetal heart rate.
2) ______________________ The four instruments use to hear the fetal heart tone.
3) ______________________ (Answers No.2-4)
4) ______________________
5) ______________________ Medical term for increase heart rate.
6) ______________________ Medical term for decrease heart rate.
 7) ______________________ Four sounds that you can hear in the abdomen of the
pregnant woman.
8) ______________________ (Answers No.7-10)
9) ______________________
10) ______________________

B. Write the number over the diagram where you would listen for the fetal heart tone
according to the fetal positions given below.

1. RMA
2. LOP
3. RSA
4. LST
5. LScT

Learning Task 2: Case Analysis

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your
responses should be detailed and direct to the point. When asked to provide several
answers, list them in order of priority or significance.
2. Please submit on or before October _______, 2021 thru Google Classroom.

You are now duty in the OB – Out-Patient Department of LPH-SPCDH. In this 24-hour duty, you
are expected to take care patients who is pregnant. Your focus on the following:
 History Taking
 Health teaching
 Nursing process

Case Analysis
Read the case scenario and apply your critical thinking.
Monique Nuque, 31 years of age, visits your clinic for her first prenatal check-up. She is in her
first trimester. She complaints vomiting and loose bowel movements for 2 days. Her blood
pressure is 90/60 mmHg, heart rate 95 bpm, respiratory rate 24 and temperature 38.2°C. The
fetal heart rate is 90 bpm, so weak to hear even using the hand-held doppler device.
A. What role does fetal heart rate assessment play during pregnancy?
___________________________________________________________________________
___________________________________________________________________________
__________________________________________

B. The FHT is 90bpm, what will be your nursing action?

___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________

C. Besides problem with the FHT, what else will be included in the care for Monique’s and her
fetus condition?
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
_____________________

Learning Task 3: Develop the nursing skills in demonstrating Fetal Heart Tone assessment.

Instructions:
1. All questions apply to this activity pertains to the concepts and theories discussed. Your
responses should be detailed and direct to the point. When asked to provide several
answers, list them in order of priority or significance.
2. Please submit on or before October_______, 2021 thru Google Classroom.
You are now duty in the OB – Out-Patient Department of LPH-SPCDH. In this 24-hour duty, you
are expected to perform Fetal Heart Tone assessment to pregnant woman. Use the checklist for
below for your return demonstration via video presentation and send via LMS. Be sure you are
wearing your clinical uniform and use the suggested supply and equipment. Your focus on the
following:
  Therapeutic Communication Technique
 History Taking
 Aseptic technique
 Providing Privacy/Confidentiality
 Computations of EDD and AOG
 Prenatal Care
 Health teaching
 Documentation of Data

CANOSSA COLLEGE
College of Nursing
San Pablo City

SKILLS CHECKLIST FOR NURSING CARE MANAGEMENT 107

1st semester, 2021-2022

Student Name:
Score:
Clinical Instructor:
Date:

Checklist: Fetal Heart Tone Assessment

Rubrics:
3 – the student was able to perform the procedures correctly based on standards
2 – the student was able to perform the procedures but needs improvement in some areas
1 –the student was not able to perform the procedure correctly because of unpreparedness showing
nervousness

Objective:
 Demonstrate the ability to count and assess the fetal heart tone using a stethoscope, a
fetoscope and/or Doppler.

Implementation 1 2 3 Remarks
Performance
1. Assess:
 The previous clinic visits.
 Retrieve the record if old patient.
 The Last menstrual period (LMP) and AOG.
 The latest FHR.
2. Assemble equipment and supplies:
 A stethoscope, a fetoscope and/or
 Doppler.
 Watch or clock with a second hand
 Water-base lubricant or KY Jelly
 Draping sheet
Procedure
3. Explain to the client what you are going to do,
why it is necessary, and how she can
cooperate.
4. Wash hands and observe other appropriate
infection control procedures.
5. Ask the client to empty her bladder.
 Prepare the client.
6. Assist the client to lie down in bed.
7. Ask the client to bare her abdomen from the
lower rib margin to the pubic bone.
8. Drape appropriately.
 Stand at the woman’s side by palpation,
determine the following:
o Fetal position
o Fetal presentation
o Fetal lie
9. Place the head of the stethoscope using the
bell side on the abdomen over the back (or
chest) of the fetus.
Or
Apply lubricant on the transducer of the
Doppler and place on the abdomen over the
back or chest of fetus.
10. Palpate the maternal radial pulse to
differentiate the maternal heart rate from
FHR.
Do the following:
 Listen and count the beats for one full minute
 Listen with an interval for 2-5 minutes for at
least twice or five times.
 Compare counts to determine variability.
11. Assess for variability of the fetal heart rate:
a. As it occurs spontaneously, and/or
b. As it occurs with fetal activity, and/or
c. As it occurs with palpation of the fetus
d. Note irregularity of heart rate or heart
sounds
e. Any increases or decreases in the FHR.
 f. Loudness of the heart tones relative to the
position of the fetus.
12. If the location of the fetal heart tones conflicts
with your assessment of #8 above, repeat #8
to be sure of the fetal position, if necessary.
13. Explain the findings to the woman.
14. Clean the Stethoscope with cotton swab or
ball and alcohol
Or
Clean the transducer and the mother’s
abdomen with clean tissue
15. Wash hands.
16. Document the results.

Remarks
Preparation – able to
gather the instruments and
able to consider safety of
the patient, able to discuss
to the patient information
prior to the performance of
the procedure) 15%
Knowledge (able to answer
questions that may be
asked by the Clinical
Instructor 15%
Performance based on the
checklist guideline (50%)
Professionalism -the
conduct of performing the
procedure (20%)

Total Grade

Evaluator:
______________________________________________
Clinical Instructor