2. Purpose
1. Determine the position of
the baby in utero
2. Determine the expected
presentation during labor
and delivery
3. Questions to ask yourself when performing the
abdominal palpation examination:
1. Is the fundal height consistent with the fetal
maturity?
2. Is the, transvelie longitudinalrse or oblique?
3. Is the presentation cephalic or breech?
4. If cephalic, is the attitude vertex or facial?
5. What is the position of the denominator?
6. Is the vertex engaged?
4. The fetal lie is either:
Longitudinal
o long axis of the fetus is alligned to the mother’s
o this is the only NORMAL position
Transverse
o long axis of the fetus is perpendicular to that of the
mother’s
Oblique
o long axis of the fetus is 0-90 degrees (or 90-180 degrees)
to that of the mother’s
6. The presentation is either:
Vertex
o head down in the pelvis
Brow
Facial
Breech
o head is up in the uterine fundus
and the buttocks is down in the
pelvis
Shoulder
7. Attitude
The attitude is the relationship of the fetal
parts to each other:
o Flexed
o Deflexed
o Extended
8. Denominator
• The denominator (center identifying letter) is
the fetal part presenting itself
Occiput - O
Sacrum - S
Mentum - M
Frontal - F
Acromion - AC or Scapula SC
11. • Full/Complete Breech
o arms & legs flexed in the
o fetal position
• Incomplete Breech
• Frank Breech
o arms flexed but legs
extended straight up over
head
• Footling Breech
o one or both feet extended
downward and may exit the
birth canal first
12. Engagement
Determined by the amount of head that is
above or below the pelvic brim
o This is usually done by dividing the head into
”fifths”
o if the head is still palpable abdominally, it is
“2/5” or less engaged
14. PURPOSES
To provide information about fetal
presentation, position, presenting part i.e. lie,
attitude, and descent
To aid in location of fetal heart rates
To aid in assessment of fetal size
To determination of single versus multiple
gestation
16. Preparation
Woman is supine, head slightly elevated and
knees slightly flexed
Place a small rolled towel under her right hip
If the nurse is R handed, stand at the woman’s R
side facing her for the first 3 steps, then turn and
face her feet for the last step (L handed, left
side).
17. First Maneuver
Facing the mother, palpate the
fundus with both hands
– Assess for shape, size, consistency and mobility
Fetal head: firm, hard, and round
– Moves independently of the rest
– Detectable by ballotement
Breech/buttocks: softer and has bony prominences
– Moves with the rest of the form
18. Second Maneuver
Determine position of the back.
Still facing the mother, place both palms on the
abdomen
o Hold R hand still and with deep but gentle pressure,
use L hand to feel for the firm, smooth back
o Repeat using opposite hands
Confirm your findings by palpating the fetal
extremities on the opposite side
o small protrusions, “lumpy”
19. Third Maneuver
Determine what part is lying
above the inlet.
Gently grasp the lower portion of the abdomen
(just above symphisis pubis) with the thumb and
fingers of the R hand
Confirm presenting part
(opposite of what’s in the fundus)
20. Head will feel firm
Buttocks will feel softer and irregular
If it’s not engaged, it may be gently pushed
back and forth
Proceed to the 4th step if it’s not engaged…
21. Fourth Maneuver
1. Locate brow.
2. Assess descent of the presenting part.
Turn to face the woman’s feet
Move fingers of both hands gently down
the sides of the abdomen towards the pubis
- Palpate for the cephalic prominence (vertex)
22. Fourth Maneuver (cont’d)
Prominence on the same side as the small parts
suggests that the head is flexed (optimum)
Prominence on the same side as the back suggests
that the head is extended