Fetal Assessment During Labor/Leopold Maneuver/ATI 13

Question 1

Leopold Maneuver

Answer 1

Leopold●maneuvers●consist●of●performing●external●palpations●of●the●maternal●uterus● through●the●abdominal●wall●to●determine●the:
■● ■● ■● ■● ■● ■●
Number●of●fetuses.
Presenting●part.
Fetal●attitude.
Fetal●lie.
Degree●of●fetal●descent●into●the●pelvis. Expected●location●of●the●point●of●maximal●impulse●(PMI).

Question 2

Expected●location●of●the●point●of●maximal●impulse●(PMI).

Answer 2

Expected●location●of●the●point●of●maximal●impulse●(PMI).

PMI●is●the●optimal●location●where●the●fetal●heart●tones●are●auscultated●the● loudest●on●the●woman’s●abdomen.●These●tones●are●best●heard●directly●over● the●fetal●back.

In●vertex●presentation,●PMI●is●either●in●the●right-●or●left-lower●quadrant●or● below●the●maternal●umbilicus.

In●breech●presentation,●PMI●is●either●in●the●right-●or●left-upper●quadrant● above●the●maternal●umbilicus.

Question 3

Leopold Maneuver: Nursing Actions

Answer 3

● Nursing Actions
Preparation of the client
■ Ask the client to empty her bladder before beginning the assessment.
■ Place the client in the supine position with a pillow under her head and have her flex her knees slightly.
■ Place a wedge under her right hip to displace the uterus to the left and prevent supine hypotension/vena cava syndrome.

Question 4

Leopold Maneuver: Fundus

STEP 1 Identify the fetal part occupying the fundus.

Answer 4

Identify the fetal part occupying the fundus. The head should feel round, firm, and move freely The breech should feel irregular and soft.

Question 5

Leopold Maneuver:

STEP 2 Identify fetal lie and presenting part

Answer 5

Identify the fetal lie and presenting part.
■ Locate and palpate the smooth contour of the fetal back using the palm of one hand and the irregular small parts of the hands, feet, and elbows using the palm of the other hand.

Question 6

Leopold Maneuver

STEP 3 Identify fetal presentation

Answer 6

■ Identify the fetal presentation.
■ Determine the fetal presenting part over the true pelvis inlet by gently grasping the lower segment of the uterus between the thumb and fingers. If the head is presenting and not engaged, determine whether the head is flexed or extended.

Question 7

Leopold Maneuver
STEP 4 IDENTIFY FETAL ATTITUDE
STEP 5 IDENTIFY THE ATTITUDE OF THE HEAD

Answer 7

Identify the fetal attitude.
■ Face the client’s feet and outline the fetal head using the palmar surface of the fingertips on both hands to palpate the cephalic prominence. If the cephalic prominence is on the same side as the small parts, the head is flexed with vertex presentation. If the cephalic prominence is on the same side as the back, the head is extended with a face presentation.
■ Identify the attitude of the head.

Question 8

Leopold Maneuver? INTERVENTIONS

Answer 8

Interventions
■ If using an external ultrasound transducer, place the tocotransducer based on the findings obtained from the maneuvers for optimal auscultation of the FHR.
■ Auscultate the FHR postmaneuvers to assess the fetal tolerance to the procedure.
■ Document the findings from the maneuvers.