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must be 24 weeks gestation.
Instruct woman to empty her bladder first
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Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles
Place a small pillow under the head for comfort.
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Drape properly to maintain privacy.
Explain procedure to the patient.
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Warms hands by rubbing together. (Cold hands can stimulate uterine contractions).
Use the palm for palpation not the fingers.
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First Maneuver:
Placement
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fundal grip - purpose?
- placement
- determine presentation, what part of the fetus is in the fundus
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Placement: procedure
- both hands
- feel for the part of the fetus that is in the fundus
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Placement: findings
- head: firm, round, moves independently from the trunk
- breech: less defined, moves with the trunk
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second maneuver
Lie
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umbilical grip:pu rpose?
- lie
- determine position, where is the fetal back
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Lie: procedure
- one hand on each side
- feel for the back and small fetal parts
- move in circular motions from top to bottom
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Lie: findings
- fetal back: smooth, hard, resistant surface
- fetal knees and elbows: several angles
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third maneuver
Engagement
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Engagement: purpose?
- engagement
- to determine the presenting part
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Engagement: procedure
- use thumb and forefinger
- grasp above the symphisis pubis
- press slightly, move from side to side
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Engagement: findings
- moveable: not engaged
- not moveable: engaged
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Fourth procedure
Attitude:
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Attitude: purpose?
determine the attitude of the fetus
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Attitude: procedure
- face foot of bed
- use both hands
- palpate head, pressing down
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Attitude: findings
chin towards chest or looking up
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