Notes

unlike the head, they move with the trunk.

Umbilical Grip

After the upper abdomen has been palpated and the form that is found is identified, attempts to determine the location of the fetal back. The health care provider palpates the abdomen with gentle but also deep pressure using the palm of the 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 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.

Pawlick's Grip

In the third maneuver, attempts to determine what fetal part is lying above the inlet, or lower abdomen. First grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. 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. The Pawlick's Grip is not recommended as it is more uncomfortable for the woman.

Pelvic Grip

The last maneuver requires the doctor to 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 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 , the occiput is instead felt and is located on the same side as the back.

Cautions

This procedure is intended to be performed by health care professionals who have had the training and instruction in how to perform them. The examiner should take care to not roughly or excessively disturb the fetus. All findings are not truly diagnostic, and as such ultrasound is required to conclusively determine the fetal position.