This should allow the identification of the fetal parts in the upper pole (fundus) of the uterus. The fundus is palpated with the fingertips of both hands facing toward the maternal xiphoid cartilage. Maneuver I: The uterine contour is outlined. (Pritchard JA, MacDonald PC: William's Obstetrics, 16th ed. The fetus is in a left occiput anterior position. What follows is a description of these maneuvers:įig. The accuracy of Leopold's maneuvers can be hampered by the maternal body habitus, the presence of uterine fibroids, multiple gestations, or polyhydramnios. Through use of Leopold's maneuvers, a clinical estimate of the fetal weight also can be obtained, although this is not a formal part of this examination. In addition, a clinical estimate of the degree of engagement of the presenting part could be made, although the final determination of engagement must be made by way of a vaginal examination. The examiner may be able to palpate the presenting part. Leopold's maneuvers 1 consist of an abdominal examination divided into four steps of palpation of the gravid uterus and fetus (Fig. The obstetrician should be able to determine the fetal lie, presentation, and position, using the maternal vertebral column and pelvis as reference points, by Leopold's maneuvers, vaginal examination, and if necessary, ultrasound. All rights reserved.To assess the potential impact of the fetus on the characteristics of the labor process, it is important that the obstetrician be knowledgeable of the basic concepts used routinely to describe how the body of the fetus is located in the uterus. The information gathered by clinical examination and ultrasound should be integrated into clinical decision making.Ĭardinal movements fetal attitude fetal descent fetal position mechanics of labor ultrasound.Ĭopyright © 2021 The Authors. Ultrasound offers a historically unique opportunity for noninvasive, dynamic studies of the mechanics of labor. We would argue that descent is the main purpose of the uterine powers and cardinal movements, a description of the rotational movements the fetal head and shoulders must perform to obtain descent. German and older English literature lists only 4 rotational movements as the cardinal movements and excludes engagement, descent, and expulsion. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. The fetus negotiates the birth canal and rotational movements are necessary for descent. Electronic address: mechanics of labor describe the forces required for fetal descent, and the movements that the fetus must perform to overcome the resistance met by the maternal bony pelvis and soft tissue. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (Drs Kahrs and Eggebø) Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (Drs Kahrs and Eggebø) Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway (Dr Eggebø).
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