Finding PMI for Continuous FHR Monitoring

cayenne06, MSN, CNM · Feb 24, 2015

leopolds is really, really useful in helping you place a fetal monitor, whether continuous or for IA. Usually I do an abbreviated version, verify the vertex and get a sense of the position. search for leopold's on youtube, you can find some good, short instructional videos.

Also, sometimes mom's body type or baby's position makes it hard, if not impossible, to actually get the FHR directly above the baby's heart. For example, on very large women, it is much easier to find and maintain CEFM in an upper quadrant. It just depends.

When doing IA on a patient with a difficult to find FHR, i often mark the spot on her belly so i can easily go back and find it again. At least, until the baby rotates or descends!

klone, MSN, RN · Feb 24, 2015

Also, ask the woman! Especially if she's had to have regular NSTs. I always ask where they usually hear the heart tones the best.

Nursero · Feb 24, 2015

Thanks! I will get more acquainted with Leopold's :)

estrellaCR, BSN, RN · Feb 25, 2015

Def ask the mom. At my hospital if we cannot locate the fetus, we ask mom "where do you feel your baby at/has moved to?" This works 95% of the time... Mom knows best ! With obese women, try for the least fat part of the belly. If the baby is low position, then lift the belly flap (sorry, i dont know the anatomical term) and secure the monitor sensor there tightly but not to the point is uncomfortable for the woman.

klone, MSN, RN · Feb 25, 2015

Pannus

cayenne06, MSN, CNM · Feb 27, 2015

Also, ask the woman! Especially if she's had to have regular NSTs. I always ask where they usually hear the heart tones the best.

YES! This is true of almost everything regarding OB. When in doubt, ask the mom.

NurseNora, BSN, RN · Mar 7, 2015

AWHONN has an Intermediate Fetal Monitoring course that includes practice doing Leopold's. It's suggested for nurses with 6 months L&D experience, so you're just ready for it. Go to AWHONN.org to look for a class in your area.