![]() A transducer is placed over the point of maximal impulse (PMI), the location on the patient’s abdomen where fetal heart tones can be heard best. The most common way to monitor the fetal heart rate is using an ultrasound transducer, a non-invasive procedure. The fetal heart rate may be monitored or assessed either externally or internally. Is the fetal head flexed (in a vertex position with chin and limbs tucked, i.e., normal) or extended (face up)? Fetal heart rate monitoring: external and internal For a cephalic presentation, face the patient's feet and use your fingers to feel for the baby’s face. If part of the fetus is pushed upward, that means it is not fully engaged in the pelvis if there is difficulty moving the pinched part, that indicates that the fetus is engaged in the maternal pelvis. Palpate above the pubic bone and “pinch” the presenting part in an attempt to distinguish how engaged the fetus is in relation to the pelvis. The baby’s back will feel smooth, versus the pointier parts of the fetus like the knees and elbows. Starting at the top, feel along both sides of the uterus to identify the location of the fetal back. Is the baby lying in a cephalic (head down) or breech (feet down) position? With the patient supine, palpate the uterine fundus (the top of the uterus) to distinguish the fetus’s position. Leopold maneuvers are also used to determine the placement of external transducers for fetal monitoring. Leopold maneuvers use external palpation (touch) of the uterus through the abdomen to determine the presenting part, fetal lie, fetal attitude, and point of maximal impulse, also known as PMI, which is the optimal location for listening to the baby’s heartbeat. ![]() This assessment provides helpful information about fetal attitude, fetal presentation, and fetal position. Named for the gynecologist Christian Gerhard Leopold, Leopold maneuvers are a technique used to assess a pregnant patient to determine where and how the baby is lying, without an invasive procedure. The Maternity Nursing series follows along with our Maternity Nursing Flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX. This article continues our discussion of fetal assessment, specifically Leopold maneuvers and fetal heart rate monitoring during labor and delivery. ^ " 'Ultrasonics Technology' job advertisement"."Investigation of Abdominal Masses by Pulsed Ultrasound". "An except from an unpublished article on the 3D Multiplanar scanner that Tom Brown invented and marketed in 1975". ^ "Electronic foetal monitoring system, United Kingdom, 1980". ![]() ^ "Image of foetal monitoring system, united kingdom, 1980". ![]() Fetal heart patterns and their clinical interpretation (PDF). "Diagnostic applications of Doppler ultrasound". "Ultrasonic Doppler systems and their use in diagnosis". ^ "Medical pioneer was 'modest man' ".^ Health and Social Service Journal, May 5, 1972, p.1012.^ "Ultrasonic foetal heart monitor, England, 1973–1978".VADS: the online resource for visual arts. The company was acquired in 1987 by Oxford Instruments and developed the product range further as "Oxford Sonicaid". Sonicaid Ltd was based in Bognor Regis in the 1970s with a unit in Livingston, Scotland, and in Chichester in the 1980s. They also developed the Sonicaid RTS5200 Real Time Scanner which was used in hospitals for obstetric applications. Sonicaid Ltd was involved in an early venture in the development of a 3D multiplanar scanner in the mid-1970s, building on the pioneering obstetric ultrasonography work by Prof Ian Donald and colleagues. Food and Drug Administration (FDA) approval in 1977 and one of these instruments is displayed at the Science Museum, London (the "machine that goes ping" in The Meaning of Life is identifiable as this model). The FM series products used both ultrasound and ECG to provide continuous monitoring (recorded on paper charts), enabling clinical interpretation of changes in fetal heart rate during contractions. The original design was due to Frederick (Doug) Fielder who was Sonicaid's medical research director. Sonicaid developed a range of fetal monitors, notably the portable Doppler ultrasound products D102, D104 ("Pocket Sonicaid", winner of a Design Council Award for medical equipment in 1976 ), D205 and D206 which provided audible output of fetal heart sounds. Sonicaid is now a registered trademark of Huntleigh Healthcare. The word "Sonicaid" is in generic use for Doppler fetal monitors. The company also developed early ultrasound scanners. Sonicaid Ltd was a medical electronics company headquartered in West Sussex best known for its range of Doppler fetal monitors.
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