3. Obstetric palpation.Leopold’s maneuvers. Fetal habitus , situs , position and presentation.

Question 1

how many grips does leopard manoeuvres consist of

Answer 1

consists of 4 grips

Question 2

when is the 1st grip done ?

Answer 2

12th week of gestation

Question 3

when is the 2,3,4th grip done ?

Answer 3

20th week of gestation

Question 4

before doing the leopard manoeuvre why should be done

Answer 4

the bladder should be empty and person needs lie on the back

Question 5

how can you work out the where the fundus begins in the fundal grip

Answer 5

palpate with your index finger gently pressing downwards and inwards feeling the very first point of resistance this will coincide with the uterine fundus.

Question 6

describe a correlation of the fundus growing ?

Answer 6

after the 12th week the uterine fundus climbs approx two fingers breadth from above the symphysis pubis every two week till the 20th week
then climbs one’s fingers breadth

the maximum fundal height is reached at 36 weeks then goes down at 40th week as baby’s head becomes engaged

Question 7

after measuring the the SFH how do we do the first leopold manoeuver

Answer 7

FUNDAL GRIP

done facing the patient’s face

The whole of the fundal area is palpated using both hands laid flat fingers close together on it to find out which pole of the fetus is lying in the fundus

If the shapes feel soft and irregular and not easily easily moveable under gentle pressure , then the baby’s buttocks occupying the fundus

If you can feel a hard, round shape in the fundus, this is the baby’s head- and the transverse groove of baby’s neck can also be felt- the breech has no groove.The head also moves independently without the trunk

If the fundus feels ‘empty’, the baby may be lying diagonally or transversely across the uterus. The second manoeuvre will help to clarify this

Question 8

what is the second grip in leopard manoeuvre called ?

Answer 8

lateral/ umbilical grip

Question 9

describe the second lateral/ umbilical leopold manoeuvre

Answer 9

done facing the patient’s face

place hands on either side of the middle of the abdomen
gently with one hand palpate one after the other while holding the other hand to steady the uterus
do this to sides and front of the uterus to find out the position of the back, limbs and the anterior shoulder

a round hard shape of the baby’s head at one side and fundus is empty : transverse lie

feel a large smooth resistant feel - this is the baby’s back which means the baby is facing inwards - in this position it is easier for the baby to start its seven cardinal movements.

comparatively empty and there are small knob like irregular /small irregular bums the toes and fingers , knees , elbows , and it is facing outwards - it is not easy for it to rotate as it passes down the birth canal

After the identification of the back, it is essential to note its position whether placed anteriorly or towards the flank or placed transversely

The position of the anterior shoulder is to be sought for. It forms a well-marked prominence in the lower part of the uterus above the head.

Question 10

describe the third leopold manuever/pawlick grip

Answer 10

done facing toward the patient’s face

determine what fetal part is lying above the inlet

your hands like a hook on the lower part of the abdomen just above symphysis pubis

if it is hard and round the presentation is cephalic
mobility from side to side

soft and irregular - breech presentation

if the baby has its back towards you - it is ocipito anterior position - does not have its back towards you occipital posterior presentation

extend of engagement is determined by how many fingers are used to grip the fetal head
all five fingers fetal head above the pelvic inlet -
head is not yet engaged

only grip it with two fingers - the head is engaged

Question 11

describe the fourth leopold manuever

Answer 11

face the woman’s feet, as he or she will attempt to locate the fetus’ brow.

fingers of both hands are placed on either side of the lower pole of the uterus , parallel to inguinal ligament, and dragged down to the symphysis pubis

The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located.

If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is felt and is located on the same side as the back

Auscultation of distinct fetal heart sounds (FHS)

the maximum intensity of the FHS is below the umbilicus in cephalic presentation and around the umbilicus in breech

In occipitoanterior position, the FHS is located in the middle of the (antioir superior iliac spine) spinoumbilical line of the same side.

In occipitolateral position, it is heard
more laterally

occipitoposterior position, well back toward the mother’s flank

Question 12

after the descend of the baby head another grip is done after leopold which is ?

Answer 12

ZANGMEISTER grip

Question 13

what is the ZANGMEISTER grip used for

Answer 13

to feel if the maternal pelvis is large enough for the passage of the foetus head

Question 14

describe the zangmeister grip

Answer 14

put the fingers of one hand on the symphysis pubis and the fingers of the other hand on descended fetal heal proximal to the symphysis

exert pressure now on both hands
if hand on symphysis pubis higher than hand on fetal head it is a good sign
if fetal head hand is higher - bad sign

Question 15

what is fetal situs

Answer 15

situs refers to the right and left orientation of fetal organs

also means - long axis of uterus in relation to long axis of fetus body

Question 16

what does fetal situs solitus mean ?

Answer 16

situs solitus is the normal left to right axis arrangement in the fetus

left side of the body -stomach and spleen
aorta
fetal cardiac axis is to the left and the left atrium is nearest to fetal spine , apex of the heart is pointing toward the left side of the fetal chest

right side -liver and gallbladder inferior vena cava

Question 17

which structures are more reliable criteria for the determination of right or left isomerism?

Answer 17

It is generally agreed that the positions of the aorta and inferior vena cava below the diaphragm are more reliable criteria for the determination of right or left isomerism than the location of the stomach in the abdomen

Question 18

how is normal fetal situs determined ?

Answer 18

ultrasound

Question 19

what is situs inversus?

Answer 19

mirror image presentation of organs

Question 20

situs ambiguus?

Answer 20

visceral malpositions and malformations

Question 21

what does fetal position mean ?

Answer 21

it describes the back of the fetus in regards to the uterine margin ,
determined with the help of the 2nd leopard manoeuvre

possible outcomes to fetal positioning:

right and left occipitoanterior

right or left ocipitotransverse

right or eft ocipitotranverse

The occipitoanterior position isdiagnosed by:

(2) Lateral grip—The back is
placed not far from the midline to the same side
of the occiput
The anterior shoulder is near
the midline 

(3) Auscultation—maximum intensity of the FHS is close to the spinoumbilical line on the same side of the baby’s back

Question 22

what is normal fetal habitus

Answer 22

flexion of the head , chin on chest ,
all limbs flexed ,
upper limbs crossed on chest , fetus takes the smallest possible ovoid volume like the shape of the uterus

Question 23

what is abnormal fetal habitus

Answer 23

fetal habitus is the relationship of one fetal part to the other
such as fetal attitude

relationship of the fetal head to its back

Abnormal fetal habitus/ altitude include a head that is tilted back, so the brow or the face presents first.

Other body parts may be positioned behind the back.

Question 24

what is fetal presentation ?

Answer 24

relation between the leading part of the fetus to the birth canal

Question 25

how many types of fetal presentation is there ?

Answer 25

cephalic
breech
shoulder
compound

Question 26

cephalic presentation is sub classified into ?

Answer 26

vertex -
sinciput
face

Question 27

compound presentation means ?

Answer 27

when other parts present along with fetal head

Question 28

how can we diagnose through palpitation of the baby is engaged ?

Answer 28

fingers of both the hands while trying to push downward on the lower abdomen
Divergence of fingers—engaged head, Convergence fingers—not engaged
Engagement of the head always excludes disproportion at the brim, as the head is the
best pelvimeter.

If the biparietal plane of a term-sized infant has descended through the inlet, the examining fingers cannot reach the lowermost part of the head. Thus, when pushed downward over the lower abdomen, the examining fingers will slide over that portion of the head proximal to the biparietal plane (nape of the neck) and diverge. Conversely, if the head is not engaged, the examining fingers can easily palpate the lower part of the head and will converge.

Question 29

when does engagement occur ?

Answer 29

engagement occurs between 38–42 weeks or even during first stage of labor. In multigravidae, however, the engagement occurs late in first stage of labor