Xiu-Xiu-week2-2.ppt

7/27/2019 Xiu-Xiu-week2-2.ppt

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Antenatal care

X iu Xiu Jiang


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Terms

Fetal liethe 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.


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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 eithercephalic orbreech presentations, respectively.

In transverse lie, the shoulderis the presenting

part.


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cephalic presentation breech presentation shoulder presentation


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Types of Cephalic presentation

Vertex or occiput

presentation

Sinciput

presentationbrow presentation face presentation


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Types of breech presentation

Frank type Complete type incomplete type or footling

presentation


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Fetal position

Refers to the relationship of an arbitrarily chosen portion ofthe fetal presenting part to the right or left side of the maternal

birth canal.

The dertermining points in vertex, face, andbreechpresentations are fetal occiput, chin (mentum), and sacrumrespectively.

The presenting part in right or left positions may be directedanteriorly (A), transversely (T), or posteriory (P). There are sixvarieties of each of the three presentations.


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Fetal positions of cephalic

presentation

Fetal positions of breech

presentation


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Diagnosis of fetal presentation and

position Abdominal palpation (Leopold maneuver)

Vaginal examination

Auscultation

imaging studies: ultrasonography, computed

tomography, or magnetic resonance imaging


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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 kneesflexed to relax abdominal muscles. Place a small pillow underthe head for comfort.

Drape properly to maintain privacy

Explain procedure to the patient.

Warms hands by rubbing together. (Cold hands can stimulateuterine contractions).

Use the palm for palpation not the fingers


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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.


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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 backis smooth, hard, and resistant

surface

Knees and elbows of fetus feels with a

number of small, irregular, mobile parts


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Third Maneuver:

To determine engagement ofpresenting part.

procedure: Using thumb and finger,

grasp the lower portion of the

abdomen above symphisis pubis, press

in slightly and make gentlemovements from side to side.

The presenting part is engaged if it is

not movable.

It is not yet engaged if it is still

movable


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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.


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Fundal Height


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THANK FOR YOUR

ATTENTION

Xiu-Xiu-week2-2.ppt

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