Definition of Terms

Fundus Latin word for bottom. In OB, fundus is the base of the uterus

Symphysis pubis - The area in the front of the pelvis where the pubic bones (the two bones of the pubis) meet.

FETAL ATTITUDE
- describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other. Suboccipito-bregmatic (Vertex) good attitude because of complete flexion: spine is bowed forward, head flexed forward so much that the chin touches the sternum, the arms are flexed and folded on the chest, thighs are flexed onto the abdomen.

Occipitofrontal moderate flexion if the chin is not touching the chest.

Military

position

Brow presentation partial extension present the brow of the head

Occipitomental poor flexion, complete extension of the head to the birth canal
This

position occurs if the amount of amniotic fluid is less than normal which does not allow the fetus adequate movement.

FETAL PRESENTATION - denotes the body part that will first contact the cervix or be born first.
Cephalic presentation the fetal head is the body part that will first contact the cervix. Breech presentation either the buttocks or the feet are the first body parts that will contact the cervix. Shoulder presentation a fetus lie horizontally in the pelvis. The presenting part is usually one of the shoulder (acromion process), an iliac crest, a hand, or an elbow

Complete breech the fetus thighs tightly flexed on the abdomen; both the bottocks and the tigthly flexed feet present to the cervix

Incomplete Breech

Frank Breech presentation attitude is moderate because the hips are flexed but the knees are extended to rest on the chest. The buttocks alone present to the cervix.

Footling Breech presentation neither the thighs nor the lower legs are flexed. If one foot is presents, it is a single-footling breech; if both present, it is a double-footling breech.

Shoulder Presentation

Fetal Position
Position is the relationship of the presenting part to the specific quadrant of a womans pelvis The maternal pelvis is divided into for quadrant according to mothers right and left
a. b. c. d.

Right anterior Left anterior Right posterior Left anterior

Four parts of a fetus have been chosen as landmark to describe the relationship of the presenting part to one of the pelvic quadrants:
a. b. c. d.

OCCIPUT in vertex position CHIN (MENTUM) in face presentation SACRUM in breech presentation SCAPULA or the ACROMION in shoulder presentation

Examples:
LEFT MENTOTRANSVERSE

LEFT OCCIPUTOANTERIOR

LEFT SACROPOSTERIOR

FETAL POSITION

EXPECTED DATE OF CONFINEMENT

NAGELES RULE
calculate the date of birth, count backward 3 calendar months from the first day of the LMP and add 7 days. Example: LMP: January 3
To

What is the EDC?

LMP: April 25, 2011 LMP: January 18, 2010 LMP: June 13, 2012

McDONALDS RULE
A symphysis-fundal height measurement is a common method of determining, during midpregnancy, that a fetus is growing in utero. The distance from the uterine fundus to the symphysis pubis in centimeter is equal to the week of gestation between 20th-31st weeks of pregnancy. 12 weeks AOG symphysis pubis 20 weeks AOG umbilicus 36 weeks AOG xiphoid process

LEOPOLDS MANEUVERS
Are a systematic method of observation and palpation to determine fetal presentation and position.

PROCEDURES
PREPARE THE CLIENT
Explain

the procedure Instruct the client to empty he bladder Position the woman supine with knees slightly flexed. Place a small pillow or rolled towel under one side. Wash your hands using warm water. Observe the womans abdomen for longest diameter and where fetal movement is apparent.

PERFORM THE FIRST MANEUVER

Stand

at the foot of the client, facing her and place both hands flat on her abdomen. Palpate the superior surface of the fundus. Determine the consistency, shape and mobility.

PERFORM THE SECOND MANEUVER

the client and place the palms of each hand either side of the abdomen. Palpate the sides of the uterus. Hold the left hand stationary on the left side of the uterus while right hand palpates the opposite side of the uterus from top to bottom. Then hold the right hand steady and repeat palpation using the left hand on the left side.
Face

PERFORM THE THIRD MANEUVER

Gently

grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and the index finger together. Determine any movement and whatever the pat firm or soft.

PERFORM THE FOURTH MANEUVER

Palpate

finger on the both sides of the uterus approximately 2 inches above the inguinal ligament, pressing downward and inward in the direction of the birth canal. Allow fingers to be carried downward.