[MATERNAL AND CHILD CARE NURSING]
/LEOPOLDS MANEUVER/
Preparation
-It is a systematic way to determine
ACTION
the position of a fetus inside the
a.Explain the procedure to the client
uterus.
b.Instruct the client to empty the
-it utilizes palpation and observation
bladder
which provides information about the c.Place a small pillow under the
number of fetuses, identity of the
client’s head
presenting part, fetal line and
d.Position the woman supine with
attitude.
knees slightly flexed. Place a small
-Named after the gynecologist
pillow or rolled towel under her left
Christian Gerhard Leopold
side.
-Maneuver is preferably performed
e.Drape the client properly
after 24 weeks gestation when fetal
Note: If the Nurse is R handed, stand
outline can be already palpated
at the woman’s R side facing her for
-The maneuvers are not truly
the first 3 steps, then turn and face
diagnostic.
her feet for the last step (L handed,
-Actual position can only be
stand at left side)
determined by ultrasound performed
f. Wash your hand using warm water
by a competent technician or
g. Observe the woman’s abdomen for
professional.
longest diameter and where the fetal
movement is apparent
Purposes
RATIONALE
1. Systematically observing and
a.Explanation reduces anxiety and
palpating the abdomen to:
enhances cooperation
b.Doing so promotes comfort and
 determine of what is in the
allows for more productive palpation
fundus
because a distended bladder will
 evaluate the fetal back and
obscure fetal contour.
extremities
c.To provide comfort for the client.
 palpate the presenting part
d.Flexing the knees relaxes the
above the symphysis
abdominal muscles
 determine the direction and
e.To provide client’s privacy
degree of flexion of the head
f. Hand washing prevents the spread
2. To aid in location of fetal
of possible infection. Using warm
heart rates
water aids in client’s comfort and
3. To determine single versus
prevents tightening of the abdominal
multiple gestation
muscles
4. The data provide the general
g. The longest diameter (axis) is the
and specific information that
length of the fetus, the location of
can be used to plan care
activity most likely reflects the
during the antepartum and
position of the feet.
intrapartum periods.
Factors Affecting Performing The
Procedure
1. Difficult to perform in Obese
patients.
2. Women with hydramnios
3. Women with full bladder
Implementation
FIRST MANEUVER
1)Stand on the foot of the bed facing
her, and placing both hands flat on
her abdomen.
2) Palpate the surface of the fundus,
determine the consistency, shape and
mobility.
3) Expecting to palpate a soft,
irregular mass in the upper quadrant
of the maternal abdomen.
(Also known as the Fundal Grip)
FINDINGS
-The fetal head is round and hard, and
moves independently of the trunk.
-The soft mass is the fetal buttocks, it
is symmetric, and has small bony
processes; unlike the head, it moves
with the trunk.
SECOND MANEUVER
1)Face the client and place the palms
of each hand on either side of the
client’s abdomen
2) While the right hand is placed
steady, palpate the opposite side of
the abdomen from top to bottom
using the left hand.
3) Do the same to the other side of
the abdomen using the right hand to
palpate the side while the left palm is
place steady.
(Known also as Lateral and Umbilical
Grip)
FINDINGS
-On one side of the abdomen, you will
palpate round nodules; these are the
fists and feet of the fetus (Kicking and
movement are expected to be felt).
-The other side of the abdomen feels
smooth; this is the fetus’s back
THIRD MANEUVER
1)While facing the client Gently grasp
the lower portion of the abdomen
just above the symphysis pubis
between the thumb and the third
finger together (to determine the
presenting part).
2)Determine any movement whether
the part is soft or firm
(also known as Pawlick’s Grip)
FINDINGS
-The unengaged is round, firm, and
ballottable
-The buttocks are soft and irregular
-Soft, presenting part at the
symphysis pubis indicates Breech
presentation.
[MATERNAL AND CHILD CARE NURSING]
FOURTH MANEUVER
/LABOR WATCH/
1)Face the client’s feet.
-To monitor the progress of women’s
2)Place your hand on the client’s
labor
abdomen, and point your fingers
-REMEMBER!!!!
toward the mother’s feet.
You will need a watch, or clock, with a
3)Then try to move the hands toward
second hand and a laboring woman!
each other while applying downward
=Contractions
pressure.
-a rhythmic tightening of the
(Pelvic Grip)
musculature of the upper uterine
FINDINGS
segment that begins mildly and
-If the hands move together easily,
becomes very strong late in labor
the fetal head has not descended into -The duration of the uterine
the maternal pelvic inlet
contraction is the time from the
-If the hands do not move together
beginning of one contraction to the
and stop to resistance met, the fetal
end of that same contraction
head is engaged into the pelvic inlet.
-During labor, the duration of the
-If you palpated the buttocks in the
contractions will start out short (25 to
fundus, then you should feel for the
35 seconds long) and ultimately get to
head.
70 – 90 seconds long.
-If one cannot feel the head, then it
=Duration
probably has descended into the
-With this progression from shorter
pelvic inlet.
contractions to longer contractions, a
mother can figure out if this is real
labor, or simply Braxton Hicks
contractions. Braxton Hicks
contractions remain irregular and do
not get progressively longer as time
passes.
=Frequency
-The frequency of the contractions is
measured from the beginning of one
contraction to the beginning of the
very next
- This not only includes the duration
of one contraction, but also the rest
period between the two. So if you
have a contraction at 8 pm and it lasts
for 60 seconds, and then you have
another contraction at 8:15 pm, the
contractions have a duration of 60
seconds and a frequency of 15
minutes
= Intensity
*contraction
-The intensity of the contractions
also changes as labor
progresses. Early labor
contractions are often described as
mild menstrual
cramps. Contractions in later labor,
have been described by some
stand-up comedians as feeling like
*frequency
your lower lip was stretched up
over your head! While this analogy is
humorous, it is true that with normal
labor, the intensity of the
contractions does increase, and this is
a good sign that labor is progressing
well.
Mild - the uterus is contracting but
does not become more than
minimally tense (tip of the nose)
Moderate - the uterus feels firm
(chin)
Strong - the contraction is so intense
that the uterus feels as hard as wood
at the peak of contraction (forehead)
Procedure
1. Explain the procedure to the
patient
2. Assist patient to a
comfortable position with
pillow on her head.
3. Sit on one side of the bed
facing the patient.
4. Rest hand on the abdomen of
the women in labor.
5. Do the labor monitoring.
Date/ti
me
Vital signs
FHT
Frequency /
duartion
Remarks
7/26/14
@ 8:00
am
T - 36.8 C
P - 89 bpm
R – 18 cpm
Bp – 120/80
mmHg
138
bpm
? / 30
sec.
mild
8:15 am
T - 36.8 C
P - 95 bpm
R – 18 cpm
Bp – 120/80
mmHg
140
bpm
15 min./ 40
sec.
moderate
[MATERNAL AND CHILD CARE NURSING]
/FUNCTIONS AND RESPONSIBILITIES
infant’s APGAR Score; hand in the
DURING INTRAPARTAL STAGE/
infant to the cord dressing nurse.
Handle
15)Deliver the placenta. (Determine
1)Wear complete DR attire including
the signs of placental separation).
mask, cap and prescribed slippers for
16)Monitor the vital signs, palpate
DR during the delivery.
fundus for size, consistency, position,
2)Do proper hand washing before the and vaginal bleeding.
delivery.
17)Reassure the patient. Provide
3)Prepare sterile sets (OB pack),
post-partum instructions.
supplies, drapes and equipment
18)Complete the DR records and
needed in the delivery.
patient’s chart.
4)Place patient on the DR table and
19)Assist in the transport of the
assist in lithotomy position. Elevate
patient to the ward together with her
patient’s legs simultaneously and
infant.
position in stirrups, adjusting to leg
Cord Care
length, provide padding to prevent
1)Wear complete DR attire including
pressure on popliteal veins and
mask, cap and prescribed slippers for
nerves, provide hand grips.
DR during the delivery.
5)Cleanse the vulva and perineal area. 2)Do proper hand washing before the
delivery.
3)Gather equipment and supplies
needed for the newborn care.
4)Prepare pre-heated linens/mattress
or warmer.
5)Check infant’s weighing scale for
correct
6)Do gloving.
6)Prepare the suction machine if
7)Drape the patient aseptically.
properly functioning.
8)Catheterize patient if bladder is
7)Receive the baby after cutting the
full.( Should have physician’s order)
cord and place in a pre-heated crib.
9)Coach patient for most effective
8)Aspirate remaining secretions using
pushing using abdominal muscles
bulb syringe.
upon contractions
9)Dry up the infant thoroughly and
10)Monitor maternal vital signs and
change wet linens.
fetal heart tones following
10)Evaluate further APGAR score.
contractions and pushing.
Take vital signs.
11)Deliver the baby’s head, shoulder
11)Perform cord dressing aseptically.
and body announcing and showing
- Cord is tied off 1 inch from the base
the sex of the baby to the mother
and expose to air. - Dress the cord
while laying on patient’s abdominal
with 70 % ethyl alcohol.
drape. Note the time of birth
12)Weight the baby
12)Support the perineum during the
13)Measure head, chest and
delivery.
abdominal circumference in
13)Loosen and slip the loops of cord if
centimeters.
fetal head has cord coil before the
14)Dress the baby
shoulder are delivered.
15)Administer eye prophylaxis.
14)Clamp cord coil with 2 clamps
16)Administer Vitamin K to R anterior
during the delivery. ( curve Kelly
thigh
forceps-towards the mother,
Full term - 1 mg IM
Straight Kelly forceps - towards the
Preterm - 0.5 mg IM
baby ) - If no cord coil, cut the cord 8 17)Administer Hepatitis B1
10 inches from the infant’s umbilicus
immunization on L anterior thigh.
after pulsation ceases. - Evaluate
18)Attach wrist ID band. -Indicating
the sex of the baby, Family name,
Date and Time of Delivery
19)Assist Pediatrician in the
evaluation of Ballard score.
20)Bedded in to mother for
breastfeeding.
21)Clean used instruments and pack.
22)Complete the infant’s chart and
endorse to NICU staff, or give to the
appropriate significant other.
Complete DR record.
=The Department of Health(DOH Ph)
embarked on Essential Newborn Care,
a new program to address neonatal
deaths in the country. Under the
umbrella of the Unang Yakap
Campaign, Essential Newborn Care is
an evidenced based strategic
intervention aimed at improving
newborn care and helping cub
neonatal mortality.
=The Essential Newborn Care
package is a four-step newborn
care time bound intervention
undertaken to lessen newborn death.
-Immediate and thorough drying to
stimulate breathing after delivery of
the baby
-Provision of appropriate thermal
care through mother and newborn
skin-to skin contact maintaining a
delivery room temperature of 25-28
degrees centigrade and wrapping the
newborn with clean, dry cloth.
-Properly timed clamping and cutting
of the umbilical cord, (1-3 minutes or
until cord pulsation stops)
-Non-separation of the newborn and
mother for early breast-feeding.
Immediate latching on and initiation
of breastfeeding within first hour
after birth
=Post-natal care required within 24
hours after birth also includes
*Cord care
*NB screening
*Breastfeeding
*Vitamin K Injection
*Eye prophylaxis
*Delayed bathing until 6 hours of life
*BCG and first dose of Heb B
*Immunization