CNM Certified Nurse Midwife

Category - Antepartum

A nurse midwife is performing the Leopold’s maneuver on a client at 28 weeks’ gestation. The assessment findings are noted as follows: First maneuver - the fundus is felt with soft, irregular shaped mass that is difficult to move; Second maneuver - The client’s left side feels smooth and hard, and a number of angular nodulations are felt on the client’s right side; Third maneuver - The presenting part is movable; Fourth maneuver - The brow is easily palpated on the same side of the angular nodulations. Which of the following conclusions is not consistent with the findings?
  1. The buttocks of the fetus are located at the uterine fundus.
  2. The fetus is at the anterior position.
  3. The fetal back is located on the mother’s left side.
  4. The presenting part is not engaged.
Explanation
Answer: B - The fetus is at the posterior position. If the brow is easily palpated, the fetus is at the posterior position, where the occiput is pointing toward the client’s back. The first maneuver indicates that the buttocks are located at the uterine fundus. The uterus would feel hard, firm and round if the fetal head in the uterine fundus. The second maneuver indicates that the fetal back is located on the mother’s left side. The angular nodulations are the knees and the elbows. The presenting part is not engaged because it is not movable.
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