Antenatal care
X iu Xiu Jiang
Terms
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Fetal lie
the relationship of the long axis of the fetus to that of the
mother.
If the two are parallel, then the fetus is said to be in a
longitudinal lie (present in over 99 percent of labors at term).
If the two are at 90-degree angles to each other, the fetus is
said to be in a transverse lie.
If the fetal and the maternal axes may cross at a 45-degree
angle, forming an oblique lie, which is unstable and always
becomes longitudinal or transverse during the course of labor.
Fetal presentation
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The portion of the fetal body that is either
foremost within the birth canal or in closest
proximity to it
In longitudinal lies, the presenting part is either
cephalic or breech presentations, respectively.
In transverse lie, the shoulder is the presenting
part.
cephalic presentation
breech presentation
shoulder presentation
Types of Cephalic presentation
Vertex or occiput
presentation
Sinciput
presentation
brow presentation face presentation
Types of breech presentation
Frank type
Complete type
incomplete type or footling
presentation
Fetal position
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Refers to the relationship of an arbitrarily chosen portion of
the fetal presenting part to the right or left side of the maternal
birth canal.
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The dertermining points in vertex, face, and breech
presentations are fetal occiput, chin (mentum), and sacrum
respectively.
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The presenting part in right or left positions may be directed
anteriorly (A), transversely (T), or posteriory (P). There are six
varieties of each of the three presentations.
Fetal positions of cephalic
presentation
Fetal positions of breech
presentation
Diagnosis of fetal presentation and
position
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Abdominal palpation (Leopold maneuver)
Vaginal examination
Auscultation
imaging studies: ultrasonography, computed
tomography, or magnetic resonance imaging
Leopold maneuver
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Leopold maneuver is established by Leopold in1848
Preparations before examination
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
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First Maneuver:
To determine fetal part lying in the fundus.
To determine presentation.
procedure: Using both hands, feel for the
fetal part lying in the fundus.
Head is more firm, hard and round, and is
more mobile and ballottable.
Breech feels as a large, nodular mass.
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Second Maneuver:
To identify location of fetal back.
To determine position.
Procedure: 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
surface
Knees and elbows of fetus feels with a
number of small, irregular, mobile parts
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Third Maneuver:
To determine engagement of
presenting part.
procedure: 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 engaged if it is
not movable.
It is not yet engaged if it is still
movable
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Fourth Maneuver:
To determine if the presentation has
descended into the pelvis
 To determine the position of the fetal
presentation
procedure: Facing foot part of the woman,
using the tips of the first three fingers,
exerts deep pressure in the direction of
the axis of the pelvic inlet
Use both hands.
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Fundal Height
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