Abdominal Palpation for

Fetal Position
 Purpose

1. Determine the position of

the baby in utero
2. Determine the expected
presentation during labor
and delivery
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?
 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
Fetal Lie
 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
 Attitude

 The attitude is the relationship of the fetal

parts to each other:

o Flexed
o Deflexed
o Extended
 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
PRESENTATION ATTITUDE DENOMINATOR

Vertex Flexed Occiput

Deflexed
Brow Frontal
(vertex)
Extended
Facial Mentum
(vertex)
Breech Sacrum
Acromion/
Shoulder
Scapula
 Flexed Vertex Presentation
8 Possibilities

 LOL ROP
 ROL LOP
 LOA OP
 ROA OA
• 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
 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
Leopold’s Maneuver
 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
Leopold’s Maneuver

 Four-part process

 Palpation of fetal
position in-utero
 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).
 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
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”
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)
 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…

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)
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