Ail En
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First maneuver While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feels softer, is symmetric, and has small bony processes; unlike the head, it moves with the trunk.
Physical Exam – Your doctor will check your blood pressure, height and weight. Aside from assessing your overall health, your doctor will also particularly assess your heart, lungs and breasts.
•
Pelvic Exam – A Pap smear is done in order to check for cervical cancer and other sexually transmitted diseases like gonorrhea and chlamydia. A bimanual internal exam is also performed to determine the size or the uterus and pelvis. This may cause a slight discomfort but it is essential in checking for abnormalities in the uterus, ovaries and fallopian tubes.
•
Complete Blood Count – This test is done to determine infection, presence of anemia and to determine clotting ability.
•
Serologic Test for Syphillis – Syphillis must be treated in early in pregnancy to prevent fetal damage. The deformities may range from bone and tooth deformities to nerve and brain damage.
•
Blood Typing – This is important because pregnant women with bleeding tendencies need to have blood available in case of emergencies.
•
Maternal Serum for Alpha-Fetoprotein (MSAFP) – This test is important in determining neural tube and abdominal defects in the fetus. It is usually conducted at 16 to 18 weeks of gestation.
•
Rubella – This test is done to screen for immunity against German measles. Most Americans are immune against rubella because vaccinations are given during childhood. If you didn’t get the vaccine, avoid people with this disease. Although it may be rare, it can cause very serious complications for your baby.
•
Antibody Titers for Hepatitis B (HBsAg) – This test is used to screen for Hepatitis B, which may be transmitted to the baby during childbirth.
•
Varicella – This test is used to screen for immunity against chickenpox. This test is usually ordered for women who have no history of the disease. An exposure during pregnancy may have harmful effects to the baby.
•
Urinalysis – Doctors need to test your urine to check for kidney disease and bladder infections. This test can also detect high levels of sugar which may indicate diabetes. Bladder infections are common among pregnant women, and if left untreated, it may cause problems for the baby.
•
Indirect Coombs’ Test – This will determine if Rh antibodies are present. An Rh factor is a protein on the surface of the blood cells that trigger an immune system response. If a woman is Rh negative and her partner is Rh positive, the baby’s blood type may not match, and it may cause Rh incompatibility. The incompatibility will trigger the mother’s body to produce antibodies that may be harmful to the baby. Thus, an injection of Rh immune globulin (Rhogam) during the 28th week of pregnancy is essential. This injection is also given in the event of bleeding during pregnancy and after delivery of the baby.
•
HIV Test – This test in pregnancy is optional, but it is recommended because it allows a HIV positive woman to begin therapy with Zidovudine (AZT). AZT may decrease the risk of the infant developing the disease. Women who have a history of using intravenous drugs, and who have multiple sex partners are encouraged to undergo testing. This may be a very important but it is never mandatory, so women have the right to refuse testing.
Second maneuver After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palms of his or her hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. Third maneuver - Pawlick's Grip In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneauver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. Fourth maneuver The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is the resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back . Cautions Leopold's maneuvers are intended to be performed by health care professionals, as they have received training and instruction in how to perform them. That said, as long as care is taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine fetal lie. Nageles rule Means of estimating date of delivery by counting back three months from the first day of the last menstrual period and adding seven days. Nägele rule (na ´gĕ-le) a method for calculating the estimated (or expected) date of confinement (EDC) or of delivery (EDD): count back three months from the first day of the last menstrual period, and then add one year and seven days. An unavoidable error of plus or minus two weeks may occur. McDonald rule (mәk-don´әld) the length in centimeters of the abdominal contour from the upper margin of the pubic symphysis to the fundus of the uterus, divided by 3.5, gives the duration of pregnancy in lunar months; applicable only after the sixth month of pregnancy.
•
Genetic Tests – Your doctor may also order genetic tests to determine illnesses that can be passed to the baby as a result of defective genes. Doctors would usually prescribe this depending on your medical history and ethnic background. People of Mediterranean descent, Blacks, French Canadians and Jews have a higher risk of having Tay-Sach’s disease, sickle cell anemia and thalassemia.
Physical Exam – Your doctor will check your blood pressure, height and weight. Aside from assessing your overall health, your doctor will also particularly assess your heart, lungs and breasts.
•
Pelvic Exam – A Pap smear is done in order to check for cervical cancer and other sexually transmitted diseases like gonorrhea and chlamydia. A bimanual internal exam is also performed to determine the size or the uterus and pelvis. This may cause a slight discomfort but it is essential in checking for abnormalities in the uterus, ovaries and fallopian tubes.
•
Complete Blood Count – This test is done to determine infection, presence of anemia and to determine clotting ability.
•
Serologic Test for Syphillis – Syphillis must be treated in early in pregnancy to prevent fetal damage. The deformities may range from bone and tooth deformities to nerve and brain damage.
•
Blood Typing – This is important because pregnant women with bleeding tendencies need to have blood available in case of emergencies.
•
Maternal Serum for Alpha-Fetoprotein (MSAFP) – This test is important in determining neural tube and abdominal defects in the fetus. It is usually conducted at 16 to 18 weeks of gestation.
•
Rubella – This test is done to screen for immunity against German measles. Most Americans are immune against rubella because vaccinations are given during childhood. If you didn’t get the vaccine, avoid people with this disease. Although it may be rare, it can cause very serious complications for your baby.
•
Antibody Titers for Hepatitis B (HBsAg) – This test is used to screen for Hepatitis B, which may be transmitted to the baby during childbirth.
•
Varicella – This test is used to screen for immunity against chickenpox. This test is usually ordered for women who have no history of the disease. An exposure during pregnancy may have harmful effects to the baby.
•
Urinalysis – Doctors need to test your urine to check for kidney disease and bladder infections. This test can also detect high levels of sugar which may indicate diabetes. Bladder infections are common among pregnant women, and if left untreated, it may cause problems for the baby.
•
Indirect Coombs’ Test – This will determine if Rh antibodies are present. An Rh factor is a protein on the surface of the blood cells that trigger an immune system response. If a woman is Rh negative and her partner is Rh positive, the baby’s blood type may not match, and it may cause Rh incompatibility. The incompatibility will trigger the mother’s body to produce antibodies that may be harmful to the baby. Thus, an injection of Rh immune globulin (Rhogam) during the 28th week of pregnancy is essential. This injection is also given in the event of bleeding during pregnancy and after delivery of the baby.
•
HIV Test – This test in pregnancy is optional, but it is recommended because it allows a HIV positive woman to begin therapy with Zidovudine (AZT). AZT may decrease the risk of the infant developing the disease. Women who have a history of using intravenous drugs, and who have multiple sex partners are encouraged to undergo testing. This may be a very important but it is never mandatory, so women have the right to refuse testing.
Second maneuver After the upper abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palms of his or her hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus. This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. Third maneuver - Pawlick's Grip In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneauver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth. Fourth maneuver The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is the resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back . Cautions Leopold's maneuvers are intended to be performed by health care professionals, as they have received training and instruction in how to perform them. That said, as long as care is taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine fetal lie. Nageles rule Means of estimating date of delivery by counting back three months from the first day of the last menstrual period and adding seven days. Nägele rule (na ´gĕ-le) a method for calculating the estimated (or expected) date of confinement (EDC) or of delivery (EDD): count back three months from the first day of the last menstrual period, and then add one year and seven days. An unavoidable error of plus or minus two weeks may occur. McDonald rule (mәk-don´әld) the length in centimeters of the abdominal contour from the upper margin of the pubic symphysis to the fundus of the uterus, divided by 3.5, gives the duration of pregnancy in lunar months; applicable only after the sixth month of pregnancy.
•
Genetic Tests – Your doctor may also order genetic tests to determine illnesses that can be passed to the baby as a result of defective genes. Doctors would usually prescribe this depending on your medical history and ethnic background. People of Mediterranean descent, Blacks, French Canadians and Jews have a higher risk of having Tay-Sach’s disease, sickle cell anemia and thalassemia.
