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Antenatal care
X iu Xiu Jiang
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Terms
Fetal liethe 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.
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Fetal presentation
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 eithercephalic orbreech presentations, respectively.
In transverse lie, the shoulderis the presenting
part.
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cephalic presentation breech presentation shoulder presentation
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Types of Cephalic presentation
Vertex or occiput
presentation
Sinciput
presentationbrow presentation face presentation
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Types of breech presentation
Frank type Complete type incomplete type or footling
presentation
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Fetal position
Refers to the relationship of an arbitrarily chosen portion ofthe fetal presenting part to the right or left side of the maternal
birth canal.
The dertermining points in vertex, face, andbreechpresentations are fetal occiput, chin (mentum), and sacrumrespectively.
The presenting part in right or left positions may be directedanteriorly (A), transversely (T), or posteriory (P). There are sixvarieties of each of the three presentations.
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Fetal positions of cephalic
presentation
Fetal positions of breech
presentation
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Diagnosis of fetal presentation and
position Abdominal palpation (Leopold maneuver)
Vaginal examination
Auscultation
imaging studies: ultrasonography, computed
tomography, or magnetic resonance imaging
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Leopold maneuver
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 kneesflexed to relax abdominal muscles. Place a small pillow underthe head for comfort.
Drape properly to maintain privacy
Explain procedure to the patient.
Warms hands by rubbing together. (Cold hands can stimulateuterine 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 backis 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 ofpresenting part.
procedure: Using thumb and finger,
grasp the lower portion of the
abdomen above symphisis pubis, press
in slightly and make gentlemovements 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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THANK FOR YOUR
ATTENTION