Prenatal Procedures

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P r e n a ta l
Procedures
Jona Marie D. Paez, RM, MN
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Fundal Height
Determination
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Measuring Fundal Height Procedure
To measure fundal height, use pliable but not stretchable
tape measure and follow these steps:
1. Explain the procedure
2. Instruct client to empty her bladder.
3. Help the woman into a supine position and drape her
appropriately to provide privacy; expose her abdomen.
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4. Position one end of the tape measure at the

notch of the symphysis pubis (a little below the
hairline).
5. Pull the tape measure up and over the abdomen
to the top of the fundus, being careful not to tip the
corpus of the fundus back.
6. Measure the distance in centimeter.
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Click to editHEIGHT
FUNDAL Master title style
MEASUREMENT
WEEKS CM LANDMARK
16 WEEKS 12 – 16cm Above symphysis pubis
20 WEEKS 17 – 20cm Below umbilicus
24 WEEKS 21 – 24cm Level of umbilicus
28 WEEKS 25 – 28cm Above umbilicus
32 WEEKS 29 – 32cm Between Umbilicus & Xiphoid

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Process
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Click
Mcto donald’s
edit MasterRule
title style
Uses fundal height to

determine the duration of a
pregnancy.
Using a tape measure and
recording the distance from
the superior aspect of the
symphysis pubis to the uterine
fundus in cm. as the woman
lies supine.
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As a rule of thumb your fundal height
(inClick
cm) to edit Master
is equal title style
to the weeks of
gestation (valid between 20th and 32nd
weeks of pregnancy).
McDonald’s Rule: Computing in Weeks
FH [in cm] x 8/7 = GA in weeks
Problem: What is the estimated gestational age in

weeks if the fundic height is 21 cm?
Solution: 21 x 8 = 24 weeks
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Click to FH
editLARGER
Master THAN
title style FH SMALLER THAN
EXPECTED EXPECTED
Thicker uterus Baby prematurely descending into the

pelvis
Full Bladder
Taller or slim stature baby Short stature baby
Twins
Well conditioned abdominal muscles Loose abdominal muscles
Miscalculated due date Miscalculated due date 12

Leopold’s
Maneuver
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Four maneuvers for assessing

fetal position, presentation, degree
of descent and fetal attitude by
external palpation of the mother's
abdomen.
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Fetal
Click to editposition
Master title style
 Describes the location of a

fixed reference point on the
presenting part in relation to
the four quadrants of the
maternal pelvis
 LOA, LOP, ROA, ROP, RSA,

LMP
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A B C D
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PRESENTATION
Cephalic /Vertex presentation
BREECH PRESENTATION
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Cephalic presentations
OCCIPUT/VERTEX BROW FACE
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Click
Breechto edit Master title style
presentations
FRANK BREECH FULL BREECH FOOTLING BREECH
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ATTITUDE
Flexion
is
normal
FLEXED EXTENSION
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LIE
 the relationship of the long axis of the fetus to

the long axis of the woman
Transverse lie - uncommon
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OBJECTIVES
• To identify number of fetuses

• To determine fetal presentation, lie, presenting part,
degree of descent, and fetal attitude
• To identify point of maximum intensity (PMI) of fetal
heart rate (FHR) in relation to the woman’s abdomen
• To monitor the descent and internal rotation of the fetus
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EQUIPMENT
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Click to edit Master
FACTORS title style
AFFECTING
THE
PERFORMANCE OF MANEUVER
 Difficult to perform in obese women

 Women with hydramnios
 Women with full bladder
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PROCEDURE
STEPS
1. Wash hands.
2. Ask woman to empty bladder.
3. Position woman in supine position with one pillow under her head
and with her knees slightly flexed.
4. Place small rolled towel under woman’s right hip.
5. If right-handed, stand on woman’s right facing her.
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6. FIRST MANEUVER. Identify fetal part that occupies the fundus. The head
Click feels
to edit Master title style
round, firm, freely movable and palpable by ballottement; the breech
feels less regular and softer.
***What fetal part is in fundus

(Fundal Grip)
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SECOND title style
MANEUVER. Using palmar surface of one hand, locate and palpate
the smooth convex contour of the fetal back and the irregularities that identify
the small parts (feet, hands, elbows).
Palpate for
Back
(Umbilical Grip)
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Click
8. THIRDtoMANEUVER.
edit Master Withtitle style
the right hand, determine which fetal part is
presenting over the inlet to the true pelvis. Gently grasp the lower pole of the
uterus between the thumb and fingers, pressing in slightly. If the head is
presenting and not engaged, determine the attitude of the head.
Palpate for
engagement of
presenting part
(Pawlick’s Grip) 32
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FOURTH MANEUVER. Turn to face gravida’s or client’s feet. Using two (2)
Click tohands,
9.
editoutline
Master title style
the fetal head with palmar surface of fingertips.
Palpate position
of head –
determine
descent &
flexion
(Pelvic Grip)
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10. Reposition patient for comfort.
11. Wash hands.
12. Chart fetal presentation, position, and lie; whether presenting

part is flexed or extended, engaged or free floating.
13. Use hospital’s protocol for charting (e.g. “VTX, LOA, Floating).
Leopold’s Manuever Link: https://www.youtube.com/watch?v=KQ3L1n5XiLw

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FHB
(Fetal Heart Beat)
Determination/
Fetal monitoring
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Determination Of Point
Click to edit Master Ofstyle
title Maximum Intensity
(PMI) Of Fetal Heart Rate (FHR)
STEPS
1. Wash hands.
2. Perform Leopold’s Maneuvers.
3. Auscultate fetal heart rate using stethoscope / Doppler
apparatus.
4. Apply fetal monitor PRN.
5. Wash hands.
Fetal Monitoring: https://www.youtube.com/watch?v=N9hNCjaL_dE 38

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Location of FHR in
relation to the more
commonly seen fetal
positions.
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• Location of FHR in
relation to the commonly
seen fetal position.
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Read here: A pregnant woman will
Click to edit Master title style undergo series of changes in her body
and system. Health teaching is given by the midwife during antenatal to
help the woman anticipate the changes.
Task1: Compare and Contrast

Create a table and compare the physiological and psychological
changes that is happening to a mother from pre-pregnancy state to
pregnancy state. As a student midwife how can you help her prepare for the
birth of her child especially for first time mothers?
Submit your output next meeting
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Prenatal Procedures

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Jona Marie D. Paez, RM, MN

4. Position one end of the tape measure at the

16 WEEKS 12 – 16cm Above symphysis pubis

20 WEEKS 17 – 20cm Below umbilicus

24 WEEKS 21 – 24cm Level of umbilicus

28 WEEKS 25 – 28cm Above umbilicus

32 WEEKS 29 – 32cm Between Umbilicus & Xiphoid

Uses fundal height to

McDonald’s Rule: Computing in Weeks

FH [in cm] x 8/7 = GA in weeks

Problem: What is the estimated gestational age in

Thicker uterus Baby prematurely descending into the

Taller or slim stature baby Short stature baby

Well conditioned abdominal muscles Loose abdominal muscles

Miscalculated due date Miscalculated due date 12

Four maneuvers for assessing

 Describes the location of a

 LOA, LOP, ROA, ROP, RSA,

Cephalic /Vertex presentation

OCCIPUT/VERTEX BROW FACE

FRANK BREECH FULL BREECH FOOTLING BREECH

 the relationship of the long axis of the fetus to

Transverse lie - uncommon

• To identify number of fetuses

 Difficult to perform in obese women

***What fetal part is in fundus

11. Wash hands.

12. Chart fetal presentation, position, and lie; whether presenting

Leopold’s Manuever Link: https://www.youtube.com/watch?v=KQ3L1n5XiLw

Fetal Monitoring: https://www.youtube.com/watch?v=N9hNCjaL_dE 38

Task1: Compare and Contrast

Submit your output next meeting

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