Definition

It is a standard palpation of the abdomen for assessing the fetal position, presentation and degree of descent.

Purposes
To determine the number of fetuses.  To identify the presentation, position, degree of descent, and attitude of the fetus.  To identify the point of maximum intensity of the fetal heart tone in relation to the woman’s abdomen.

Materials
Stethoscope  Doppler

Procedure

Wash hands.
 ®:To deter the spread of microorganisms


Explain the procedure to the patient.
 ®:To gain cooperation

Let the patient empty her bladder deviate before the procedure.  Position the patient on supine with one pillow under her head and with knees slightly flexed.
 ®: To facilitate accurate assessment providing

comfort. Flexed knees relieve tension of abdominal musculature

If right handed, stand at woman’s right facing the patient.  First Maneuver: Face the patient and palpate the uterine fundus to determine what part of the fetus lies in the upper part of the fundus.

 ®:Head feels hard and round, freely

movable and ballotable; breech feels large, nodular, and softer.

Second Maneuver: Palpate in a downward direction on the sides of the abdomen applying gentle but deep pressure to determine the position of the fetal extremities, fetal back and anterior shoulders.
 ®:On side of fetal back, a long

continuous structure will be felt; side of extremities will feel nodular.

Third Maneuver: Place one hand over the symphisis pubis and grasp the lower uterine segment between the thumb and fingers to feel the presenting part.
 ®: If engagement has occured, fetal

part feels fixed in the pelvis. The head is at inlet or in pelvis, if the presenting part is still movable, it is not engaged.

Fourth Maneuver: Turn and face the woman’s feet to confirm the findings of the third maneuver and determine the flexion of the fetus’ head into the pelvis.
 ®:The cephalic prominence is felt on

side where there is greater resistance to the descent of the vertex.

Locate again the back of the fetus and place the stethoscope over it and listen to the fetal heart tone fo one full minute.
 ®:Normal FHT is 120-160 beats per minute.

Note the location, rate and character of the FHT  Make the patient comfortable  Document the observation made; fetal findings, presentation, position, attitude and whether engaged or floating.

 ®:To promote data base for future.