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Antenatal care. X iu Xiu Jiang. Terms. Fetal lie the relationship of the long axis of the fetus to that of the mother. If the two are parallel, then the fetus is said to be in a longitudinal lie (present in over 99 percent of labors at term).
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Antenatal care X iu Xiu Jiang
Terms • Fetal lie the relationship of the long axis of the fetus to that of the mother. • If the two are parallel, then the fetus is said to be in a longitudinal lie (present in over 99 percent of labors at term). • If the two are at 90-degree angles to each other, the fetus is said to be in a transverse lie. • If the fetal and the maternal axes may cross at a 45-degree angle, forming an oblique lie, which is unstable and always becomes longitudinal or transverse during the course of labor.
Fetal presentation • The portion of the fetal body that is either foremost within the birth canal or in closest proximity to it • In longitudinal lies, the presenting part is either cephalic or breech presentations, respectively. • In transverse lie, the shoulder is the presenting part.
cephalic presentation breech presentation shoulder presentation
Types of Cephalic presentation Vertex or occiput presentation Sinciput presentation face presentation brow presentation
Types of breech presentation Frank type Complete type incomplete type or footling presentation
Fetal position • Refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the maternal birth canal. • The dertermining points in vertex, face, and breech presentations are fetal occiput, chin (mentum), and sacrum respectively. • The presenting part in right or left positions may be directed anteriorly (A), transversely (T), or posteriory (P). There are six varieties of each of the three presentations.
Fetal positions of breech presentation Fetal positions of cephalic presentation
Diagnosis of fetal presentation and position • Abdominal palpation (Leopold maneuver) • Vaginal examination • Auscultation • imaging studies: ultrasonography, computed tomography, or magnetic resonance imaging
Leopold maneuver • Leopold maneuver is established by Leopold in1848 • Preparations before examination • Instruct woman to empty her bladder first. • Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. • Drape properly to maintain privacy • Explain procedure to the patient. • Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). • Use the palm for palpation not the fingers
First Maneuver: To determine fetal part lying in the fundus. To determine presentation. procedure: Using both hands, feel for the fetal part lying in the fundus. • Head is more firm, hard and round, and is more mobile and ballottable. • Breech feels as a large, nodular mass.
Second Maneuver: • To identify location of fetal back.To determine position. Procedure: One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts.Use gentle but deep pressure. • Fetal back is smooth, hard, and resistant surfaceKnees and elbows of fetus feels with a number of small, irregular, mobile parts
Third Maneuver: • To determine engagement of presenting part. procedure: Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. • The presenting part is engaged if it is not movable. • It is not yet engaged if it is still movable
Fourth Maneuver: • To determine if the presentation has descended into the pelvis • To determine the position of the fetal presentation procedure: Facing foot part of the woman, using the tips of the first three fingers, exerts deep pressure in the direction of the axis of the pelvic inlet Use both hands.
