Leopold's Maneuver | Return Demonstration

Shekinah

8 Aug 202108:47

Summary

TLDRIn the video, Sripayna Aquino Maranga demonstrates Leopold's maneuver, a non-invasive method used to determine the position and engagement of a fetus in the uterus after 36 weeks of gestation. The procedure involves four specific maneuvers to palpate the uterus and locate the fetal back and heart tones. The video provides a step-by-step guide, emphasizing the importance of patient comfort, proper handwashing, and infection control. The outcome of the demonstration indicates a cephalic presentation with the baby's head engaged, ideal for labor, and a normal fetal heart rate of 125 beats per minute.

Takeaways

🤰 Leopold's maneuver is a systematic palpation technique used to determine the position and presentation of a fetus in the uterus.
👩‍⚕️ It is typically performed after 36 weeks of gestation to prepare for labor and assess the need for a cesarean section.
🧼 The procedure requires hand washing and preparation of equipment such as a pillow, towel, and stethoscope to ensure hygiene and comfort.
🛌 The patient is positioned supine with a pillow under her head and a towel under her hip to facilitate the examination.
🤲 The maneuver consists of four steps: fundal grip, umbilical grip, pollux grip, and pelvic grip, each revealing different aspects of fetal position and engagement.
👶 The fundal grip helps to identify if the fetal head or breech is in the upper part of the uterus.
🔍 The umbilical grip involves palpating the lateral uterine surface to locate the fetal back or extremities.
🤝 The pollux grip is used to determine if the fetal head has engaged in the pelvis.
🔎 The pelvic grip confirms the findings of the pollux grip and identifies the presenting part in the hypogastrium.
💓 After the maneuvers, the fetal heart tone is located and listened to for at least one minute to assess the baby's well-being.
📝 The procedure concludes with the nurse covering the patient, ensuring comfort, and documenting the findings.

Q & A

What is Leopold's maneuver and why is it performed?
-Leopold's maneuver is a systematic palpation technique used to determine the position, presentation, and engagement of the fetus inside the uterus. It is performed after 36 weeks of gestation to help prepare for labor and to assess the need for a cesarean section.
What are the necessary equipment and preparations before performing Leopold's maneuver?
-The necessary equipment includes a pillow, a towel, and a stethoscope. Preparations involve hand washing to prevent infection and ensuring the patient's comfort by having her void before the procedure.
Why is it important to void before Leopold's maneuver?
-Voiding before the maneuver is important as an empty bladder promotes comfort and allows for a more productive examination. A distended bladder can obscure the fetal contour and may slightly deviate the uterus.
How does the patient need to position herself during Leopold's maneuver?
-The patient should be positioned supine with one pillow under her head and a flexed knee, with a towel placed beneath her hip to displace the uterus off the inferior vena cava and aorta, preventing supine hypotensive syndrome.
What is the purpose of the fundal grip in Leopold's maneuver?
-The fundal grip is the first maneuver, where the uterine fundus is palpated to determine which part of the baby is at the upper part of the uterus, such as the fetal head or breech.
How does the umbilical grip help in Leopold's maneuver?
-The umbilical grip involves palpating the lateral uterine surface to determine the fetal back or extremities by applying gentle but deep pressure.
What is the purpose of the pollux grip in the maneuver?
-The pollux grip is used to grasp the lower uterine segment and determine if the fetal head is engaged, providing information about the baby's position in the birth canal.
What does the pelvic grip reveal during Leopold's maneuver?
-The pelvic grip is performed to confirm the findings of the pollux grip and to determine the presenting part in the hypogastrium of the mother, as well as the fetal head position (flexed or extended).
Why is it important to locate the fetal back and listen for the fetal heart tone after the maneuvers?
-Locating the fetal back and listening for the fetal heart tone are important to confirm the baby's position and to ensure the baby's well-being, with a normal heart rate being around 120-160 beats per minute.
What is the significance of the cephalic position mentioned in the script?
-A cephalic position indicates that the baby's head is at the lower part of the uterus and is engaged, which is the ideal position for labor, suggesting a potentially easier delivery.
What is the normal fetal heart rate and what does it indicate?
-A normal fetal heart rate is between 120-160 beats per minute. In the script, a rate of 125 beats per minute indicates that the baby's heart rate is within the normal range, suggesting good fetal health.

Outlines

00:00

🤰 Introduction to Leopold's Maneuver

The video script introduces Leopold's maneuver, a non-invasive method used to palpate the gravid uterus and determine the position and presentation of the fetus. It is typically performed after 36 weeks of gestation to prepare for labor. The narrator, Sripayna Aquino Maranga, prepares by gathering necessary equipment such as a pillow, towel, and stethoscope, and emphasizes the importance of hand washing to prevent infection. The patient is greeted, and consent is obtained for the procedure. The patient is instructed to void to ensure comfort during the examination, as a full bladder can affect the accuracy of the maneuver. The patient is then positioned supine with a pillow under her head and a towel under her hip to prevent supine hypotensive syndrome.

05:05

👶 Performing Leopold's Maneuver

The script details the steps of performing Leopold's maneuver, which includes four specific grips: the fundal grip to identify the fetal head or breech at the fundus, the umbilical grip to locate the fetal back or extremities, the pollux grip to check for engagement of the fetal head, and the pelvic grip to determine the presenting part and fetal position. The procedure is conducted with the patient's comfort in mind, and the area of examination is exposed only as needed. The narrator explains each step to the patient and performs the maneuvers gently. After the maneuvers, the fetal back is located, and the fetal heart tone is listened to for at least one minute. The procedure concludes with the patient being covered and the findings discussed, which in this case indicate a cephalic presentation with the fetal head engaged, an ideal position for labor. The fetal heart rate is found to be normal at 125 beats per minute. The script ends with the narrator offering to answer any questions and performing hand washing and documentation of the findings.

Mindmap

Keywords

💡Leopold's Maneuver

Leopold's Maneuver is a systematic technique used by healthcare providers to palpate the gravid uterus. It is a non-invasive method to determine the position, presentation, and engagement of the fetus within the uterus. In the video, this maneuver is performed by the nurse to assess the expectant mother's condition and prepare for labor. The maneuver is named after Dr. Leopold, who developed it and is crucial for prenatal care, as it helps in identifying the optimal fetal position for delivery.

💡Gravid Uterus

The term 'gravid uterus' refers to the uterus of a pregnant woman, which is enlarged due to the presence of the fetus. In the context of the video, the Leopold's Maneuver is performed to palpate this area to assess the fetus's position. The uterus plays a central role in pregnancy, housing and nurturing the developing baby, and its examination is vital for monitoring fetal health and preparing for delivery.

💡Fetal Position

Fetal position refers to the orientation of the baby within the mother's womb. It is a critical factor in determining the ease and safety of childbirth. In the video, the nurse uses the Leopold's Maneuver to ascertain the baby's position, which is identified as cephalic, indicating the baby's head is down, an ideal position for labor. Correct fetal positioning is essential for a smooth delivery process.

💡Presentation

Presentation in obstetrics denotes the part of the fetus that is closest to the birth canal. It is a significant aspect of prenatal assessment as it influences the mode of delivery. The video script mentions that the maneuver helps determine the presentation of the fetus, which is crucial for planning the labor process and deciding whether a vaginal delivery or cesarean section is more appropriate.

💡Engagement

Engagement refers to the degree to which the fetal presenting part has entered the pelvic inlet. It is an important milestone in pregnancy, indicating the baby's readiness for birth. In the video, the nurse checks for engagement by using the pollux grip during the Leopold's Maneuver, which helps to determine if the baby's head has descended into the pelvis, preparing for labor.

💡Supine Hypotensive Syndrome

Supine Hypotensive Syndrome, also known as aortocaval compression, occurs when the pregnant woman lies flat on her back, causing the uterus to press on the inferior vena cava and aorta, potentially leading to a drop in blood pressure. The video script describes placing a pillow under the patient's head and a towel under the hip to prevent this syndrome, ensuring the comfort and safety of the mother during the examination.

💡Fundal Grip

The fundal grip is the first of the four maneuvers in Leopold's technique. It involves palpating the uterine fundus to determine which part of the baby is in the uppermost part of the uterus. In the video, the nurse performs the fundal grip to feel if it's the fetal head or the breech that is in the upper part, providing essential information about the baby's position within the uterus.

💡Umbilical Grip

The umbilical grip is the second maneuver in Leopold's Maneuver, where the healthcare provider palpates the lateral uterine surface to determine the location of the fetal back or extremities. This step is crucial for understanding the overall fetal positioning and is demonstrated in the video as the nurse applies gentle but deep pressure to ascertain the baby's position.

💡Pollux Grip

The pollux grip is the third maneuver in the Leopold's Maneuver, where the examiner places a hand over the symphysis pubis and grasps the lower uterine segment to determine if the fetal head is engaged. This is a critical step in assessing the baby's position and readiness for birth, as shown in the video where the nurse performs this grip to check for engagement.

💡Pelvic Grip

The pelvic grip is the final maneuver in the Leopold's Maneuver, used to confirm the findings from the pollux grip and to determine the presenting part in the hypogastrium of the mother. It also helps to ascertain the fetal head's position—whether it is flexed or extended. In the video, the nurse uses this grip to finalize the assessment of the baby's position and readiness for labor.

💡Fetal Heart Tone

Fetal heart tone refers to the sound of the baby's heartbeat, which is an essential aspect of prenatal care to ensure the baby's well-being. In the video, after completing the Leopold's Maneuver, the nurse listens for the fetal heart tone for at least one minute to check its rate and rhythm. A normal fetal heart rate, as mentioned in the script, is between 110 and 160 beats per minute, indicating a healthy fetus.

Highlights

Introduction to Leopold's maneuver as a non-invasive method to determine the position and presentation of the fetus.

Leopold's maneuver is performed after 36 weeks of gestation to prepare for labor.

The procedure helps in deciding if a cesarean section is safer.

Preparation includes a pillow, towel, stethoscope, and hand washing to prevent infection.

Introduction of the student nurse and the patient, establishing rapport.

Explanation of the purpose of Leopold's maneuver to the patient.

Request for patient's consent and comfort during the procedure.

Instructions for the patient to void to ensure comfort and accurate examination.

Positioning the patient for the examination to prevent supine hypotensive syndrome.

Beginning the first maneuver, the fundal grip, to determine the upper part of the fetus.

Differentiating between the fetal head and breech through palpation.

Proceeding with the second maneuver, the umbilical grip, to find the fetal back or extremities.

The third maneuver, the pollux grip, to check for fetal engagement.

The fourth maneuver, the pelvic grip, to confirm findings and determine the fetal position.

Locating the fetal back and listening for the fetal heart tone.

Completion of the procedure and covering the patient for comfort.

Findings shared with the patient: baby's position and heart rate.

Confirmation of the baby's cephalic position and engagement, ideal for labor.

Normal fetal heart rate of 125 beats per minute.

Offering the patient an opportunity to ask questions post-procedure.

Concluding the procedure with hand washing and documentation of findings.