1) The document describes the steps of a pelvic exam to determine fetal position and presentation. 2) It involves four maneuvers - fundal grip to find the fetal part in the fundus, umbilical grip to identify the back, Pawlik's grip to check engagement, and pelvic grip to assess head flexion and attitude. 3) Each maneuver feels for specific fetal parts like the head, back, knees, or brow to determine presentation, position, and degree of engagement.

1. Preparation: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.PurposeProcedureFindingsFirst Maneuver:Fundal GripTo determine fetal part lying in the fundus. To determine presentation.Using both hands, feel for the fetal part lying in the fundus.Head is more firm, hard and round that moves independently of the body.Breech is less well defined that moves only in conjunction with the body.Second Maneuver:Umbilical GripTo identify location of fetal back.To determine position.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 feel with a number of angular nodulationThird Maneuver:Pawlik’s GripTo determine engagement of presenting part.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 not engaged if it is not movable. It is not yet engaged if it is still movable.Fourth Maneuver:Pelvic GripTo determine the degree of flexion of fetal head. To determine attitude or habitus.Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament.Use both hands.Good attitude – if brow correspond to the side (2nd maneuver) that contained the elbows and knees.Poor atitude – if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards woman’s back)