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After watching this video

the clinician will be able to perform Leopold's Maneuvers,

assess the fetal status through use of Doppler or fetoscope,

perform an accurate measurement of the uterine fundus,

and make a general assessment of maternal

and fetal well-being within the accepted length of parameters.

Hi Becky, how are you feeling?

Fine.

Baby moving good?

Mhm.

Moving at least 10 times a day? Being active?

Mhm.

You having any problems with swelling?

Just hot.

Just hot, yeah.

What about any bad headaches, blurry vision,

spots before your eyes, anything unusual going on?

No.

Position the woman comfortably with a pillow

under her head and shoulders.

Her knees should be bent slightly

and her arms should be at her sides.

With clean, warm hands prepare the woman

draping her lower body, and exposing her abdomen

for examination.

Be sure the woman has emptied her bladder

prior to the examination.

A full bladder can make the fundal height

seem higher than it actually is.

Facing the woman, locate the symphysis pubis

and the top of the fundus.

Remember, the symphysis pubis has nothing to do

with the pubic hairline.

Place your hands along each side of her abdomen

and palpate to the top of the fundus

noting the size, shape, consistency, and mobility.

The part of the fetus that is smooth, firm, and curved

is the fetal back.

And the small, knobby, irregular bumps are fetal knees,

feet, elbows, and hands.

This determines the lie of the fetus.

You may feel movement or kicking on the side.

Grasping the area above the symphysis pubis

between your thumb and middle finger,

press gently but firmly into the abdomen.

This maneuver allows you to ascertain the presenting part.

If the presenting part is the fetal head

the mass will be moveable and ballotable,

able to move fully between fingers

unless it is engaged in the pelvis.

Using the combined Pawlick grip

you will be able to convey the presenting part

with the top of the fundus.

If the presenting part is ballotable,

and if the top of the fundus moves the whole span of the fetus,

the fetal lie is in the vertex position.

Next, facing the woman's feet,

place your hands on the lower sides of the uterus

with your fingers toward the symphysis pubis.

Press deeply with your fingertips into the abdomen

in the direction of the pelvic inlet.

You will feel a hard, round protrusion:

the cephalic prominence.

If the head is in the vertex position,

it will be well-flexed

and you will feel the prominence on the same side

as the small fetal parts.

If the presenting part is engaged within the pelvic inlet,

you will not be able to feel it.

A tape measure is commonly used to measure the fundal height.

First, locate the woman's superior border

of the symphysis pubis at the midline.

Hold the "zero" end of the tape measure here

and pull the tape over the abdomen to the top of the fundus.

The measurement in centimeters

should correspond to the weeks of gestation.

For example, 35 weeks equals 35 centimeters.

Variables to this measurement include positions of the fetus

such as breech, transverse lies,

and lightening, and engagement.

Note that too much elevation of the women's torso

can affect the accuracy of the measurement.

[Doppler sounds, heart beat]

Having previously located the back of the fetus

during the Leopold's meneuvers,

you will be able to judge with some accuracy

where to listen for the fetal heart tones, or FHT.

[heart tones]

For a term fetus in the vertex position,

you can locate the fetal heart tones below the umbilicus

on either side of the midline, the left or lower right quadrant

(LLQ, or RLQ) depending on the lie.

For a fetus in the posterior position,

fetal heart tones are close to the midline

or in the flank area,

in which case you would be listening to the fetal chest.

Let's be sure and get the gel off.

And I always like to assess the weight of the baby

toward the end of the pregnancy.

I bet this baby is about six and a half pounds right now.

And we're about three weeks away from her due date

so, about another eight pound baby.

if it comes on time.

Alright, do you have any questions Becky?

Do you really think it's going to be an eight pound baby?

Well if you're right on time I think it will.

Hi Jennifer.

Hi.

How are you doing today?

Very good.

Heavy moving day? [???]

Mhm, more active.

More active, that's what I like to hear.

Are you having any problems?

No.

Swelling any?

Just a little.

Just a little. Any severe headaches? Blurred vision?

Spots before your eyes?

No.

Okay, well let's check you

and see what this baby's doing today.

Starting at the bottom of the fundus.

Assess the fundus, until you...the uterus until you

find the fundus.

Top of the uterus, right here.

Here is your baby's back

mostly on top.

This feels like a fetal head right there.

I think this baby's in the breech position.

This is the baby's bottom right down here.

So the baby's curled up this way.

And we should hear fetal tones

right about here.

[beep]

[Doppler sounds, fetal heart tones]

The fetal heart tones of a breech presention

will be level with or above the umbilicus.

Okay.

Starting

from the top of the pubic bone.

The really superior portion of the pubic bone

to the top of the fundus.

The baby's position can really [???] on the fundal height measurement.

Breech.

Transverse lie.

When the baby's head is on one side

and then his bottom is on the other then you get

a smaller fundal height measurement.

So whatever position the baby is in

can make a big difference in the measurement

that we get each time.

It's better if the measurement's taken by the same person

every time.

Feel a lot of kicking and moving over on this side?

Mhm.

Probably a lot right down in here.

Mhm.

Has anything changed?

I think I dropped down more.

Okay. That's always a good sign.

Let's see how this baby's laying.

The sides, and I can feel a little fin [?] or something over here.

[???] if he never moves.

Baby's bottom is right up here.

Feels like we got back pretty much coming across the top.

Press deeply with your fingertips into the abdomen

in the direction of the pelvic inlet.

You will feel a hard, round protrusion,

the cephalic prominence.

If the head is in the vertex position

it would be well-flexed and you would

feel the prominence on the same side as the small fetal parts.

If there is a base presentation

you should feel the prominence of the occiput

on the same side as the fetal back.

If the presenting part

is engaged within the pelvic inlet

you will not be able to feel it.

This position is referred to as dipping.

Let's see where our measurement is this week.

Sometimes as a baby's head gets lower

the measurement goes down a little bit

instead of up.

You're right around there.

Be sure to record all the findings on position,

measurement, and fetal heart tones rate,

and location for future reference and comparison.

His head is really low.

It's under the symphysis pubis,

what we call dipping down.

From your assessment of fetal status

you may also be able to estimate fetal weight.

I think you've got about an eight pound baby right now.

The mother's heart rate by Doppler or fetoscope

will be much slower and make a swishing sound.

If you are unsure whether you are hearing the fetus or the mother

check the mother's radial pulse as you listen to the heart rate.

Once you identify the fetal heart tones,

take a moment to assess the rate and strength of them.

Fetal heart tones are rapid and deep,

usually around 130-160 beats per minute.

Everything looks really good.

Okay, do you have any questions?

These visits also provide an opportunity

to discuss the overall health of the mother.

General physical feeling,

genitourinary status,

edema, nausea, energy and fatigue level,

nutritional intake,

account of fetal movement,

and any concerns of either of you.

Vital signs and urine tests are necessary each visit.

Share your findings with the woman

and be open for her questions.

Communication is key in establishing confidence

between you and your client.

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