NCM 107 Care of Mother, Child PDF

NCM 107: Care of Mother, Child, Adolescent (Well-Client) Module 2F: Obstetric Anatomy Premature Death - A mother who has vices all throughout her...

NCM 107: Care of Mother, Child, Adolescent (Well-Client) Module 2F: Obstetric Anatomy Premature Death - A mother who has vices all throughout her pregnancy, drinking smoking, etc., has a very bad psychological development not - In this module, you will learn about the bony just for her pregnancy but towards other structures with the most importance for people, pregnant woman and the baby she will give - The mother is eating a lot of sugar or birth to. unnecessary food intake - The bones of the skeleton have the main ➔ We all know that sugar is prohibited function of supporting our body weight and ➔ If there is too much consumption of it, acting as attachment points for our muscle. it could lead to gestational diabetes - The female pelvis supports the major load - The mother is also stressed all throughout of the pregnant uterus and the fetal skull her pregnancy, eating a lot of unhealthy which has to pass through the woman’s foods like pizza, coffee, bacon, wine, etc. pelvis when she gave birth. ➔ Could result to signs and symptoms of disability Conceptual Framework ➔ It if is not treated, it could lead to premature death not just for the mother but also for the baby. Labor - A series of events by which uterine contractions and abdominal pressure expel a fetus and placenta from the uterus - It is the process of delivering a baby and the placenta, the membranes, and umbilical cord from the uterus to the vagina to the outside world - In our conceptual framework, we have here a mother who is pregnant First Stage of Labor - Dilatation High Level Wellness - The cervix dilates fully to a diameter of about - If the mother is going through her regular 10 cm (2 inches) prenatal checkups, the mother is also performing yoga and exercises, eating a First stage of labor is divided into 2 phases: lot of healthy foods and fruits and 1. Latent Phase vegetables, have a good support system 2. Active Phase and has a good psychological development Theories of Labor - The mother is aware of everything that is - Normally begins between 37 and 42 weeks good for her baby and is educated ➔ As early as 37 or as late as 42 enough, then it will lead her to a high level - If the labor can begin before fetus is mature wellness this is premature labor - If labor occurs or is delayed until fetus and placenta have both passed beyond the optimal point for birth this is termed as post term labor MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) - The exact mechanism that triggers the onset Passage of labor is unknown - Refers to the maternal pelvis ➔ There are a lot of mechanism that could - Refers to the route that the fetus must travel trigger the onset of labor from the uterus through the cervix and vagina Current beliefs that focus on the combination of to the external perineum occurrences as responsible for initiating the FOCUS: start labor: - Shape of Pelvis Uterine stretching - Bony Structures ➔ Also caused by hormones or increase or - Pelvic Diameter decrease in hormones that could affect - Soft Tissues the uterine wall Changes in estrogen and progesterone Pelvis balance Oxytocin Stimulation Cervical Pressure Prostaglandin production by the fetus Aging of the placenta Increased Fetal Cortisol Level Components of Labor There are four (4) important components of labor which must work together for a normal labor process - From an obstetrical standpoint, it is useful to to begin: consider the bony pelvis as a whole rather than a separated part 1. Passage - A pelvis is a bony ring formed by four united ➔ Refers to the maternal pelvis itself bones: 2. Passenger 1. Two innominate (flaring hip) bones ➔ A maternal pelvis should be suitable to 2. The coccyx also the passenger which refers to the 3. The sacrum fetus - These four bones serve both to support and 3. Power protect the pelvic organs ➔ Refers to the amount of push the mother - These united bones together also form four will exert during the delivery joints 4. Psyche ➔ Or psychological development of the mother is very important all throughout her pregnancy process ➔ Could refer to the past experiences a mother had prior to pregnancy If one is altered in these four components of labor, the outcome of labor can be adversely affected. MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Four Pelvic Joints Pelvic Divisions: - The bony structures of the pelvis, including - The pelvis is anatomically divided into a the pelvic joints and bones are important in False Pelvis and a True Pelvis the labor and delivery. 1. Symphysis Pubis 2. Right Sacroiliac Joint 3. Left Sacroiliac Joint 4. Sacrococcygeal Joint - Pelvic joints to provide stability to the pelvis. - The bony line being the brim of the pelvis False Pelvis - located in the superior half of the pelvis - the upper portion of the pelvic inlet → support the internal organs and upper body True Pelvis - located in the inferior half of the pelvis Pelvis (Parts and Functions) - includes the pelvic inlet, pelvic outlet, and pelvic - Vital in the birthing process cavity - Innominate bones: ilium (upper and lateral - Chiefly of concerned of the obstetrician as it forms portion), ischium (inferior portion), and pubis the canal through which the fetus has to pass - Hip (the crest of the ilium) Pelvic Inlet - Ischial tuberosities (important markers - entrance to the true pelvis used to determine lower pelvic width) - also called as the pelvic brim - Ischial spines (mark the midpoint of the Pelvic Outlet pelvis) - inferior portion of the true pelvis Pelvic Cavity - Symphysis pubis - space between the inlet and the outlet - Sacrum (upper posterior portion of the pelvic ring) - Coccyx (below the sacrum) Front View Pelvic inlet is the upper portion while the middle part is a pelvic cavity and the lower part or the lowest part is the pelvic outlet. - The line that separates between the true pelvis and the false pelvis: Imaginary line (LINEA TERMINALIS) which separates the false pelvis from true pelvis MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Difference of a Male and a Female Pelvis 2. Android-shaped Pelvis Male Pelvis - “Male” pelvis - Its arc is only 70 degrees = acute angle - The pubic arch forms an acute angle, making - It is much more narrower and longer than the the lower dimensions of the pelvis extremely female pelvis narrow - A fetus may have difficulty exiting from this Female Pelvis type of pelvis ➔ Sometimes it could lead into cesarean - Its arc is 90 to 100 degrees = obtuse angle delivery or it could lead to a forceps anatomically called sub arc delivery or a vacuum delivery - It is much broader and larger ➔ It depends on a lot of factors Types of Pelvis 1. Gynecoid-shaped Pelvis - “Female” pelvis - Has an inlet that is well-rounded forward and backward - Has a wide pubic arch - Ideal type for childbirth - Most common type of pelvis for women - This is what we call as the “child bearing 3. Anthropoid-shaped Pelvis hips” - “Ape-like” pelvis - A lot of women has a very perfect body like a ➔ Shaped as a monkey wide hips and betty boop type of body, or in - The transverse diameter is narrow old terms like coca-cola body - The anteroposterior diameter of the inlet is - Easy passage of the fetal skull and the larger than usual shoulders - It’s oval with longer anteroposterior diameter MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) 4. Platypelloid-shaped Pelvis - “Flattened” pelvis - Has a smoothly curved oval inlet, but the anteroposterior diameter is shallow - The pelvis is super wide and super big that it causes a lot of factors to have a difficulty delivering the baby because the shape of this pelvis is flattened oval - A lot of women, mostly in the states, women who are obese have a flattened pelvis, very big and super wide hips GYNECOID (50%) ANDROID (20%) ANTHROPOID (25%) PLATYPELLOID (5%) PELVIC BRIM Slightly ovoid or Heart shaped Oval, wider Flattened transversely angulated anteroposteriorly anteroposteriorly rounded ROUND HEART OVAL FLAT DEPTH Moderate Deep Deep Deep SIDEWALLS Straight Convergent Straight Straight ISCHIAL Blunt, somewhat Prominent, narrow Prominent, often with Blunt, widely SPINES widely separated interspinous narrow interspinous separated SACRUM Deep, Curved Slightly curved, Slightly curved Slightly curved terminal portion often beaked SUBPUBIC Wide Narrow Narrow Wide ARCH USUAL MODE - Vaginal - Cesarean - Vaginal Vaginal OF DELIVERY Spontaneous - Vaginal * Forceps - Spontaneous (Occipitoanterior Difficult with * Spontaneous position) forceps (Occipitoanterior/posterior Position) - 50% of women have gynecoid pelvis - Usual mode of delivery (gynecoid): normal - 20% of women have android pelvis spontaneous vaginal delivery if the position - 25% of women have anthropoid pelvis of the baby is in occipitoanterior position - 5% of women have platypelloid presentation is on occiput MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) ➔ Flexion is fully flexed: position of the baby occipitoanterior, fully flexed meaning chin is touching the chest - Usual mode of delivery (android): usually cesarean ➔ Women should assess first their body types and pelvic types before getting pregnant so to be prepared for financial circumstances; there are times the ob depending on the factor causes what, Sagittal View vaginal but with the help of forceps or vacuum - Anteroposterior is from the sacrum to the - For anthropoid, vaginal but with the help of pubis (sagittal view) forceps and sometimes it is NSVD, but the - Anteroposterior Diameters: 11 cm of the position of the baby should be pelvic inlet considered adequate for vaginal occipitoanterior or occipitoposterior. delivery ➔ The position of the babies should - The use of 3 conjugates is very important in coincide with the type of pelvis that we the birthing process are going to deliver - Pelvic inlet is considered adequate for - For platypelloid, we have vaginal vaginal delivery if the measurement of their spontaneous delivery, but the size of the fetal conjugates are as follows: skull should be proportionate with the True Conjugate: 4 3/8” (11cm) or diameter or the measurements of the pelvic greater cavity itself  Also called as the Anatomical Conjugate Pelvic Inlet Diameters and Measurements: Diagonal Conjugate: 4 7/8” to 5 1/8” - Pelvic inlet is in the true pelvis and the upper (12.5cm to 13cm) part of the true pelvis Obstetric Conjugate: 10 cm Anteroposterior View Pelvic Outlet Diameters and - Anteroposterior Diameters: 11 cm Measurements:  From the pubis to the sacrum - Pelvic Outlet is considered as adequate for (anteroposterior view) vaginal delivery if the following - Transverse Diameter: 5 3/8 inches (13.5cm measurements are as follows: or greater) Anteroposterior Diameter: 4 5/8”  From the ilium to the ilium of the pelvis (11.7cm) - Oblique Diameter: 5 inches (12.7cm)  From sacrum or symphysis pubis to coccyx Transverse / Intertuberous Diameter: 3 7/8” to 5 3/8” (10 to 13.5 cm)  From left ischial tuberosity to the right side of ischial tuberosity Posterior Sagittal Diameter: 3 ½ inches (9cm)  From this part here to the sacral iliac joint  Either left or right MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Fetal Skull - Size is important as the fetus travels through the birth canal - Fetal skull is very important because this is very significant during the labor and delivery as we also check for any disabilities - Fetal skull is some extent compressible and made mainly of thin pliable tubular flat bones - Contains 8 bones: ➔ 2 fused frontal bones ➔ 2 parietal bones ➔ 1 occipital bone ➔ Anchored to the rigid and incompressible bones at the base of the skull Soft Tissues - Also play a role in labor and delivery - The lower segment of the uterus expands to accommodate the intrauterine contents as the walls of the upper segment thicken - Other 4 bones of the skull: - There are also a lot of factors which also ➔ Sphenoid causes the intrauterine wall to soften and that ➔ Ethmoid also aids the passage of the baby going out ➔ 2 temporal bones - The cervix is drawn up and over the - The bones meet at suture lines composed of presenting part as it descends strong, flexible, fibrous tissue which allow the - The Vaginal Canal distends to accommodate cranial bones to move and overlap, making it the passage of the fetus possible for the skull to decrease in size Passenger - Refers to the fetal skull - Refers to the fetus and its ability to move through the passage and affected by several fetal features: Presentation Attitude Station - It is very important to know the type of Lie sutures of the skull because for example, Position during delivery or when the baby is delivered you will experience conditions like caput succedaneum, molding, cephalohematoma, etc… ➔ You will determine that type of specific condition by the determinants of these suture lines MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) - Typically, the smallest diameter of the fetal - Posterior Fontanel skull is the one that enters the pelvis first. ➔ Triangular shaped - The head can flex and extend 45 degrees ➔ Formed by the junction of 3 suture lines and rotate 180 degrees, which allows its (sagittal suture anteriorly and lambdoidal smallest diameter to move down the birth suture on either side) canal and pass through the maternal pelvis. ➔ Located at the juncture of occipital and ➔ During childbirth, the fetus will rotate on parietal bones its own ➔ Measures about 0.5 to 1 cm across ➔ The fetus, while still inside, have instincts ➔ Closes on about 8 to 13 weeks already when and where to turn ➔ Is membranous but becomes bony at - Fetal skull is very important also because it term, thus truly its nomenclature as has sutures fontanel is misnomer, it denotes the position of the head in relation to the Sutures – seams between the bones of the skull maternal pelvis - Coronal – Frontal and parietal - Lambdoid – Occipital and parietal - Sagittal – Two parietal bones - Squamous – Parietal and temporal (can be viewed in a lateral view) - NOTE: These sutures fuse or they are the ones that compresses the bones Diameters of the Fetal Skull Biparietal Diameter (9.25cm) - Smallest diameter of the fetal skull - Also called as “transverse diameter” - When we say biparietal = 2 parietal are the bones that are involved in the measurement - Measure 9.25cm and it extends between 2 Fontanelles – Flexible fibrous tissue. parietal bones or eminences - Whatever may be the position of the head, - Gap between the suture lines this diameter nearly always engages - Anterior Fontanel ➔ Diamond shaped Suboccipitobregmatic Diameter (9.5cm) ➔ Located at the juncture of the frontal and - Smallest anteroposterior diameter parietal bones - Measured from the inferior aspect of the ➔ Measures 1 1/8 inch to 1 5/6 inches (3 to occiput to center of the anterior fontanelle 4cm) long and ¾ inch to 1 1/8 inch or 2 to - Bregma – forehead 3 cm wide - Occipito – occiput ➔ Formed by joining of the four sutures. (2 - Measure up to down frontal bones and 2 parietal bones) ➔ Closes on about 12 to 18 months MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Occipitomental Diameter (13.5cm) Moderate Flexion - Occipitofrontal Diameter presents in the - Widest anteroposterior diameter birth canal - Measured from the posterior fontanelle to the - One who presents during the birth that chin refers to either the brow - This diameter is usually what we are going to see if the fetus or the baby is in full flexion meaning good flexion Poor Flexion ➔ Because the chin of the baby will touch - When the head is hyperextended the chest - Largest diameter ➔ What we are going to see is the - Occipitomental Diameter presents in the birth canal occipitomental or vertex part Poor Flexion results to: Factors of Unusual Fetal Position: Degree of Flexion Small mother - The degree of flexion is very important during The position of the baby is not very the labor and delivery because this is where accurate during the delivery, so the baby we can determine that the baby is or will pass would have a malposition which results to the line passage or the maternal pelvis in poor flexion Small uterus good condition ➔ The baby would curl up Full Flexion Malformed fetus - Fetal head flexes so sharply Uterine fibroids - The chin rest on the chest Multiple fetus or gestation - Smallest anteroposterior diameter and ➔ Example: The twin A is in a good suboccipitobregmatic diameter is present position, and we can deliver the twin A in the birth canal or the first baby successfully. During - Type of Cephalic Presentation: Vertex that time na nabilin si twin B and will ➔ Most reliable presentation during suddenly malposition, this is the time childbirth we can deliver it either cesarean ➔ We can have a normal delivery and after that CS. ➔ We can also have both vaginally if both the mother has a good pelvis measurement and the baby’s position is in good position or full flexion. (Both baby) Large fetus Unusual placental site ➔ Example: If the baby has really a bad position, the placenta could dislodge, implant, block, etc… MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) When the baby is really large, and the Fetal Attitude mother’s pelvis is really small which could - Describes the degree of flexion a fetus lead to cesarean delivery because we assumes during labor and delivery or the cannot deliver the baby through normal spontaneous or NSVD relation of the fetal parts to each other. - Review: During delivery, it is in relation of the fetal parts Molding Normal Overlapping of the skull bones along the suture lines Changes in shape of the fetal skull to long and narrow shape that facilitates passage through the rigid pelvis Molding is also the alteration of the shape of the fore coming head while passing through the resistant birth passage during the labor ➔ There is however very little alteration in Complete Flexion or Full Flexion in other books = size of the head as a volume of the Vertex Presentation content inside the skull is Moderate Flexion = Military Presentation incompressible, although small amount of cerebrospinal fluid and Ang bregma ang makita blood can escape in the process During a normal delivery, usually an Poor Flexion (Extension) = Brow Presentation alteration of 4 mm in the skull diameter commonly occurs Full Extension = Face Presentation Only last a day or two Complete Flexion It is normal during delivery that mugawas Good Attitude ang tae because as the baby go outside, The usual “fetal position” or the ideal one the baby would compress the surrounding Advantageous for birth because it helps tissue or the soft tissue that is why it is also fetus presents the smallest anteroposterior affected, and the baby would compress diameter of the skull the sigmoid colon. That is why the mother Occupies the smallest place possible would poop during the delivery. Example: Molding results into that kind of shape kay sige ug Moderate Flexion push ug balik ang mother. Chin is not touching the chest anymore “Military Position or Military Presentation” Partial Extension Poor flexion It presents the brow of the head to the birth canal “Brow Presentation” MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Complete Extension Fetal Presentations Full extension - The fetal body part that will be first to pass Unusual position through the cervix and be delivered It occurs when there is less or minimal - Determined by the fetal attitude, lie and amount of amniotic fluid position (oligohydroamnios or oligohydramnios) - Affects the duration and the difficulty of labor The presentation is either the face or the - Affects the method of delivery chin - Most affected part Caput Succedaneum Fetal Lie - The relationship between the long - Cap goes across the suture lines (cephalocaudal) axis of the fetal body to the - Boggy edematous swelling of the fetal scalp long axis of a woman’s body - It usually disappears without treatment - No pathological significance Longitudinal Lie - Swelling and edema of the fetal scalp - Classified as cephalic or breech Ayaw pag libog sa molding and caput succedaneum: - Occur 96% of pregnancies - Longitudinal lie could either be the head is - Molding = when the fetal bones that are below or the head is above overlapping - Cephalic Presentation - Caput Succedaneum = edema part of the ➔ When the head is below head or swelling - Breech Presentation Subgaleal Hemorrhage ➔ When the head is above - This involves bleeding in the specific portion of the head of the baby which is the subgaleal space - Bleeding in the subgaleal space Cephalohematoma - This involves the bleeding in the periosteum Cephalic Presentation - Head presents first - Most common type of presentation: Types of Cephalic Presentation: Transverse Lie 1. Vertex - Shoulder presentation 2. Brow - When the lie is perpendicular to the mother’s 3. Face axis ➔ Poor Flexion - When the long axis of the mother is 4. Mentum (Chin) perpendicular to the fetus ➔ Complete Extension MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Breech Presentation Complete Breech - Buttocks or feet presents first Lie: Longitudinal or vertical - The presenting part for a breech presentation Presentation: Breech (sacrum and feet is the sacrum presenting) Presenting Part: Sacrum (with feet) Types of Breech Presentation: Attitude: General Flexion 1. Complete 2. Frank Shoulder Presentation 3. Footling Lie: Transverse or horizontal a. Could be Single Leg Presentation: Shoulder. Could also be the elbow b. Could be Double Leg or the knees Presenting Part: Scapula or the angel wings in the bones Attitude: Flexion - Presenting part is the shoulder, iliac crest, hand and elbow, fetus is lying horizontally in the pelvis - The mother is vertical while the baby is horizontal ➔ This is called perpendicular Causes: - Relaxation of the abdominal walls - Pelvic contraction - Placenta previa - Polyhydroamnios or Polyhydramnios ➔ There are a lot of fluid that is made up in the abdominal wall of the mother and it could lead into a lot of turning of the baby Frank Breech Lie: Longitudinal or vertical Presentation: Breech (incomplete) Presenting Part: Sacrum Attitude: Flexion, except for legs at knees Single Footling Breech Lie: Longitudinal or vertical Presentation: Breech (incomplete) Presenting Part: Sacrum Attitude: Flexion, except for one leg extended at hip and knee MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Fetal Position Four (4) Landmarks to Describe the Presenting - Relationship of the presenting part to the Part to One of the Pelvic Quadrants: specific quadrant or part and side of a 1. Vertex – Occiput woman’s pelvis 2. Face – Chin (Mentum) - Maternal pelvis is divided into 4 3. Breech – Sacrum quadrants: 4. Shoulder – Acromion Process 1. Right Posterior 2. Left Posterior 3. Right Anterior 4. Left Anterior - LOA - Most common fetal position ROA Four parts of the fetus are also chosen as - Second most common fetal position landmarks: Fetus born fastest on either position 1. Right occipitoposterior (ROP) ➔ Right part of the maternal pelvis ➔ Occiput for the fetus ➔ Posterior for the maternal pelvis 2. Left occipitoposterior (LOP) ➔ Left part for the maternal pelvis ➔ Occiput for the fetus ➔ Posterior part of the pelvis 3. Right occipitoanterior (ROA) ➔ Right side of the maternal pelvis ➔ Occiput for the fetus ➔ Anterior portion of the maternal pelvis or quadrant 4. Left occipitoanterior (LOA) ➔ Left side of the maternal pelvis ➔ Occiput for the fetus ➔ Anterior portion of the maternal pelvis or quadrant MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Engagement 7 Cardinal Movements - Refers to the settling of the presenting part Acronym: EDFIREERE (to easily memorize) of the fetus far enough into the pelvis that it E – Engagement rests to the level of the ischial spine, midpoint of the pelvis. D – Descent F – Flexion I – Internal R – Rotation E – Extension E – External R – Rotation E – Expulsion The degree of engagement is established by a vaginal examination: Floating ➔ Presenting part is not engaged Dipping ➔ Descending but not yet touched the ischial spine ➔ Nagka anam anam ug ka us us ang ulo sa baby Station - Refers to the relationship of the presenting part of the fetus to level of the ischial spine Power - Refers to the extent of push that the mother will exert during the delivery - Third important requirement for successful labor - This is very important as it is the force that is supplied by the fundus of the uterus and implemented by uterine contractions, which causes cervical dilatation and expulsion of the fetus from the uterus - As the mother felt the contraction, that is the time that she is going to push. - What will if dili pa contracted ang abdomen unya mupush siya? ➔ It could result to laceration  Magisi kay magpataka ug utong MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA NCM 107: Care of Mother, Child, Adolescent (Well-Client) Uterine Contractions Psyche - There are True Labor and False Labor - A woman’s psychological state which may or inhibit labor True Labor - It can be based on past experience as well Contractions are: as her present psychological state ➔ Regular ➔ Increase in intensity and duration with There are a lot of women nowadays, the walking psychological problems increased after giving birth. ➔ Felt in lower back, radiating to lower Taas ang postpartum depression because it started portion of abdomen in postpartum blues leads to postpartum psychosis Bloody Show and leads to postpartum depression. Dilatation and Effacement Fetus usually engaged - As a nurse, you need to orient, educate, and give awareness especially to first time mothers, single mothers, and for those False Labor mothers who are not financially capable of Contractions are irregular having a kid, and also to multigravid. Often stop with walking (mawala ra diay siya) Contractions felt in abdomen above umbilicus (abdominal pain) ➔ But does not radiate in the back or vice versa No change in cervix Fetus is ballotable Leopold’s Maneuver - Systematic method of palpation to determine the fetal presentation and position - Done as a part of physical examination L1: Fundal Grip - Findings: Fundal height and Fundal Content L2: Umbilical Grip - Findings: Fetal Back, Fetal Small Parts, and Fetal Heart Tone L3: Pawlick’s Grip or Pawlik’s Grip - Determine if Cephalic or Breech L4: Pelvic Grip - Engaged or Floating MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA