Fundic Height Measurement and Leopolds Manuever.pptx

Tool in assessing Pregnant Mothers

1. Fetal Growth Assessment

2. FUNDIC HEIGHT MEASUREMENT Fundal height is the distance between your pubic bone and the top of your  uterus  during  pregnancy .  Fundal height tells your pregnancy care provider important things about the fetus’s size, growth and position in your uterus. The distance between in centimeters depicts the week of gestation between the 20 th  to the 31 st  weeks of pregnancy.

3. McDonald’s Rule Helps in estimating fetal gestational age using fundic height. Computing in lunar months , multiply the fundic height by two, then divide by seven. FH (in cm) x 2 / 7 = gestational age in lunar months Computing in weeks , multiply the fundic height by eight, then divide by seven. FH (in cm) x8 / 7 = Gestational age in weeks. Example: FH 31.5 cm 31.5 x 2 = 63 / 7 = 9 months Example: FH 31.5 cm 31.5 x 8 = 252 / 7 = 36 weeks

4. Bartholomew’s Rule Measures the AOG by determining the position of the uterus in the abdominal cavity. 12 weeks – palpable just above the symphysis pubis. 20th or 22nd weeks – palpable at the level of the umbilicus. 36th week – touches the xiphoid process. 38th week – 2 weeks before term for primigravida the fetal head settles into the pelvis and the uterus returns to the height it was at 36 weeks.

5. Steps for measuring fundal height: 1. Patient Preparation: Ensure the patient is lying on their back, with their head slightly elevated to prevent supine hypotension.  2. Locate the Symphysis Pubis: Palpate the top of the pubic bone (symphysis pubis), which is a bony prominence at the front of the pelvis.  3. Locate the Fundus: Palpate the top of the uterus (fundus), which is the rounded top portion. You may need to gently press and feel for it.  4. Measure: Place the zero end of a tape measure at the symphysis pubis and extend it to the top of the fundus.  5. Record the Measurement: Note the measurement in centimeters. 

6. Important Considerations: Gestational Age: After 20 weeks, the fundal height in centimeters should roughly correspond to the number of weeks pregnant (plus or minus 2-3 cm).  Accuracy: Fundal height measurements can be affected by factors like obesity, fibroids, or a full bladder, so it's essential to be aware of these potential influences.  Interpretation: A fundal height that is significantly larger or smaller than expected, or that deviates from the expected growth pattern, should be investigated further.  Greater Fundic Height Indicates Multiple pregnancies Polyhydramnios Hydatidiform mole Miscalculated due date Lesser Fundic height Indicates Oligohydramnios Fetal Death intrauterine growth restriction Miscalculated AOG

7. Leopold’s Maneuver a systematic way for healthcare providers to assess fetal position, presentation, and engagement in the uterus during the third trimester of pregnancy using external palpation These maneuvers involve four distinct steps of abdominal palpation to gather information about the fetus.  Leopold's maneuvers are a low-cost, non-invasive, and easy-to-perform assessment that provides valuable information for managing labor and delivery. 

8. Purpose of Leopold Maneuvers: Determine the fetal lie (longitudinal, transverse, or oblique). Identify the fetal presentation (cephalic, breech, or shoulder). Assess the engagement of the presenting part into the pelvis. Estimate fetal weight. Determine the location of the fetal back, which is important for auscultating fetal heart sounds. 

9. The Four Leopold Maneuvers: 1. Fundal Grip: Palpate the upper abdomen (fundus) to identify which fetal part (head or buttocks) is present there.  2. Lateral Grip: Palpate the sides of the abdomen to locate the fetal back and small parts (limbs).  3. Pawlik's Grip: Palpate the lower abdomen, just above the pubic bone, to assess the presenting part (head or breech) and whether it is engaged in the pelvis.  4. Pelvic Grip: Facing the mother's feet, gently press down on the lower abdomen to assess the descent and mobility of the presenting part. 

10. 1. Gather the materials needed Tape Measure Gloves (optional) Stethoscope or Doppler Small Towels PIllow

11. 2. Provide Privacy

12. 3. Identify the patient and Introduce yourself

13. 4. Explain the procedure

14. 5. Perform Handwashing

15. 6. Position patient to Dorsal recumbent Supine with knee flexed to relax abdominal muscles Place towel or pillow to the back of the patient. Expose the necessary area only for the assessment

16. 7. Measure fundic height

17. 8. 1 st Maneuver: Fundal Grip Palpate the upper abdomen (fundus) to identify which fetal part (head or buttocks) is present there. 

18. 2nd Maneuver: Lateral Grip Palpate the sides of the abdomen to locate the fetal back and small parts (limbs) To hear the fetal heart sound • One hand is used to steady The uterus on one side of the abdomen while the other hand moves from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle deep pressure.

19. 3rd Maneuver: Pawlik’s Grip Palpate the lower abdomen, just above the pubic bone, to assess the presenting part (head or breech) and whether it is engaged in the pelvis.  Procedure : Use your thumb and finger grasp the lower portion of abdomen the above symphisis pubis • press in slightly and make gentle movements From side to side.

20. 4th Maneuver: Pelvic Grip Facing the mother's feet , gently press down on the lower abdomen to assess the descent and mobility of the presenting part.  palpate fetal head pressing downward about 2 inches above the inguinal ligament Use both hands Determine the degree of flexion of fetal head

21. Position to comfortable position, wash hands and document your findings