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Leopolds maneuver is a method that determines the fetal position, fetal presentation, and engagement. This consists of four different actions that help determine the position and presentation. With correct assessment and findings, it can indicate whether the delivery would be complicated or if the mother would need to undergo Caesarian delivery.
Maneuvers
First Maneuver This determines what part of the fetus is in the fundus. 1. Place palms on each side of the upper abdomen and palpate around the fundus. 2. If the head is at the fundus, you would feel a hard, round, and movable object. If the buttocks is at the fundus, you will feel a soft and irregular shaped mass that is difficult to move.
Second Maneuver
1. Move your hands downward, still on both sides of the abdomen, while applying firm and even pressure. 2. If you palpate a smooth hard surface on one side then it would be the fetal back. If you palpate irregular lumps it would be the hands, feet, elbows, and knees and should be on the opposite side of the abdomen.
Third Maneuver
This maneuver confirms the fetal position. 1. Place your hands above the symphysis pubis. 2. Bring the thumb and fingers together and grasp the part of the fetus between them. Findings could be the head or the buttocks.
Fourth Maneuver
This is used in the late stage of pregnancy to determine how far the fetus has descended into the pelvic inlet. 1. Place your hands on both sides of the lower abdomen close to the midline. 2. Slide your hands downward, then press inward. 3. If you palpated the buttocks in the fundus, then you shoul feel for the head. If one cannot feel the head, then it probably has descended.
Pregnancy is the conception and development of an embryo or fetus inside the uterus of a female. Pregnancy can be divided into three trimesters, lasting for 9 months or an estimated 34-36 weeks. Gravida is a term commonly used to pertain to pregnancy and it refers to the number of times a women has been pregnant. Parity or para refers to the number of successful births of a woman. Embryo is used to describe a developing offspring for the first 8 weeks and fetus is used from 2 months until birth.
Signs of Pregnancy
Presumptive Signs of Pregnancy
This signs only presume the occurrence of pregnancy and is not comfirmatory. 1. 2. 3. 4. 5. 6. 7. 8. Amenorrhea or the absence of menstruation. Nausea and vomiting Increased breast sensitivity and breast changes Increased pigmentation in localized areas Constipation Frequent urination Quickening or an initial motion Abdominal enlargement
This signs along with the presumptive and probable signs confirm pregnancy. 1. Fetal heart tone can be auscultated 2. Ultrasound of the fetus 3. Palpable fetal movements
2. There is reduced tone of esophageal sphincter that allows reflux of acidic stomach contents, producing heart burns. 3. Decreased motility in the large intestine allows more water to be absorbed and may cause constipation and hemorrhoids. 4. Increased thirst and appetite.
Discomforts of Pregnancy
Ankle Edema Backache Breast Tenderness Constipation Fatigue Headache Hemorrhoids Leg Cramps Urinary Frequency Vaginal Discharge Varicosities
Vaginal bleeding Persistent vomiting Chills and Fever Sudden escape of fluid from the vagina Abdominal or chest pain Danger signs of Pregnancy Induced Hypertension 1. Swelling of the face and fingers 2. Flashes of lights or dots before the eyes 3. Dimness or blurring of vision 4. Severe or continuous headache
Prenatal Care
The objective of prenatal care is to reach all pregnant women, to give sufficient care, and to ensure a healthy pregnancy and a birth of a full term healthy baby. Schedule of first visit is as soon as the woman missed her menstrual period and pregnancy is suspected . Follow-up visit of a mother should be once a month from 1st week to the 32nd week, twice a month for the 32nd week until the 36th week, and every week from the 36th week to the 40th week.
Lowdose Vit.A supplements (10,000 IU in 2 weeks). In areas with Malaria, 2 tablets of Chloroquine (150 mg/2 tablets every week for the duration of pregnancy). The Mechanisms of Labor occur to the fetus during delivery. Knowledge of these mechanisms enables the nurse to proceed with normal delivery and detect if any abnormalities are occurring during delivery that can enable the health care team to perform measures that could prevent possible complications. You can be guided by the acronym EDFIERERE.
E = Engagement
It is the mechanism wherein the fetus engages to the pelvis. It is also called lightening or dropping.
D = Descent
Descent is the mechanism where the fetal head begins its journey through the pelvis. Assessment measurement is termed as station.
F = Flexion
Is the mechanism where the fetal head is nodding or flexing forward toward its chest.
IR = Internal Rotation
This occurs from the occiput transverse position to the occiput anterior position while descending.
E = Extension
This enables the head to emerge when the fetus is in cephalic position. This begins when the head is crowning.
R = Restitution
It is the realignment of the head of the fetus with the body as the fetus head emerges.
ER = External Rotation
This mechanism is where the shoulders rotate externally once the head emerges and restitution occurs so that the shoulders would be in the anteroposterior diameter of the mothers pelvis.
E = Expulsion
It is the birth of the entire body of the fetus.
LABOR Labor is the coordinated sequence of involuntary uterine contractions. Understanding the stages of labor would allow the mother and the health care team facilitate a less stressful and safe childbirth. The four stages of labor are based on the changes that the uterus and cervix undergo as labor progresses.
Schultz. The presenting part is the fetal side which is shiny. Duncan. The presenting part is the maternal side which is called dirty because it is raw and red.
Do not hurry the expulsion of the placenta. This usually takes around 20 minutes. Tract cord slowly. Inspect for missing cotyledons. There should be 30. Palpate the uterus. Inject oxytocin. Inspect the perineum. Put down the legs of the mother together to prevent injury. The mother should be flat on bed without pillows for 6 hours. If the client is experiencing chills, provide her with a blanket and NOT soup. Provide additional nourishment. Allow the mother to sleep to regain her strength.
Monitoring the fetus. Monitoring the laboring woman. Helping the woman cope with labor.
4. Meconium stained. The amniotic fluid is green.. 5. If the amniotic fluid is yellow, cloudy, or has a foul odor, it may indcate infection. 6. Contractions that last for 90 secs. 7. Incomplete uterine relaxation. 8. Maternal hypotension. 9. Maternal hypertension. 10. Maternal fever.
Normal color is clear with flecks of vernix caseosa. Green stained fluid indicates the amniotic fluid is meconium stained. Cloudy or yellow amniotic fluid is infected.
The Fetal Position describes the location of a fixed reference point on the presenting bars in relation to the four quadrants. Also observed in the fetus is that the head is in flexion or is bowed, the back of the fetus is curved, and the limbs are bent and drawn up to the torso. The fetal reference is in the right or left of the mothers pelvis. O is for Occiput where the fetus is in vertex presentation, M is for Mentum or chin where the fetus is in face presentation, S is for Sacrum where the fetus is in breech presentation, and Scapula or acronio the fetus is in shoulder presentation.
Face
LOA Left Occipito Anterior LOP Left Occipito Posterior LOT Left Occipito Transverse ROA Right Occipito Anterior ROP Right Occipito Posterior ROT Right Occipito Transverse
LMA Left Mento Anterior LMP Left Mento Posterior LMT Left Mento Transverse RMA Right Mento Anterior RMP Right Mento Posterior RMT Right Mento Transverse
Breech
Shoulder
LSA Left Sacro Anterior LSP Left Sacro Posterior LST Left Sacro Transverse RSA Right Sacro Anterior RSP Right Sacro Posterior RST Right Sacro Transverse
LADA Left Acromion Dorsal Anterior LADP Left Acromion Dorsal Posterior RADA Right Acromion Dorsal Anterior RADP Right Acromion Dorsal Posterior
Fetal Lie
Fetal Lie is the orientation of the long axis of the fetus and the long axis of the woman. It has three different types the longitudinal lie, transverse lie, and the oblique lie.
Longitudinal Lie
The fetal spine is parallel with the mothers spine. Usually the fetus is in cephalic or breech presentation.
Transverse Lie
The fetal spin is horizontal or is at a right angle with the mothers spine. The presenting part of the fetus is the shoulder and delivery is usually caesarian.
Oblique Lie
The fetal spine is diagonal to the mothers spine. Delivery is by caesarian section if uncorrected.