AIIMS Delhi NO - 2017: Identify the correct obstetric grip?

AIIMS Delhi NO - 2017

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Delhi NO - 2017

Explanation

The image demonstrates an obstetric examination where the examiner's hands are placed on the lateral sides of the pregnant abdomen.
This specific hand placement corresponds to the second Leopold's maneuver, which is correctly identified as the Lateral Grip (also known as the Umbilical Grip).
The purpose of this maneuver is to differentiate the fetal back from the fetal limbs, which helps in determining the fetal position within the uterus (e.g., left or right occiput anterior).
By identifying the smooth, hard surface of the back on one side and the irregular, knobby limbs on the other, the examiner can ascertain the fetal orientation.

Option A: Pawlik's Grip is the third Leopold's maneuver. It involves using only one hand to grasp the lower uterine segment just above the symphysis pubis to determine the presenting part. The image clearly shows the use of two hands on the sides of the abdomen.
Option B: The First Pelvic Grip is the fourth Leopold's maneuver. It requires the examiner to face the patient's feet and use the fingertips of both hands to palpate the lower abdomen to assess the fetal head's attitude and engagement. The image shows the examiner facing the patient's head.
Option C: The Fundal Grip is the first Leopold's maneuver. It involves placing both hands on the top of the uterus (the fundus) to determine what fetal part (head or breech) is located there. The image shows hands on the sides of the abdomen, not the top.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of Leopold's Maneuvers (Obstetric Grips) as background academic context rather than a clinical decision trigger.
Leopold's maneuvers are a fundamental, non-invasive clinical skill for nurses and midwives to assess fetal lie, presentation, position, and engagement during antenatal check-ups and labor.
Accurate determination of the fetal back's location using the Lateral Grip is essential for correctly placing the fetoscope or Doppler to auscultate the fetal heart rate (FHR).
Identifying an abnormal lie (like transverse) or presentation (like breech) through these maneuvers is critical for planning a safe delivery and making timely referrals if needed.

How to Approach the Question

First, carefully observe the image provided. Note the position of the examiner's hands on the pregnant abdomen.
Identify the specific action being performed. In this case, the hands are placed on the lateral (side) aspects of the uterus, applying pressure inward.
Recall the four Leopold's maneuvers and their respective names and techniques: 1. Fundal Grip, 2. Lateral Grip, 3. Pawlik's Grip, and 4. Pelvic Grip.
Match the observed action in the image with the correct maneuver. The hand placement corresponds to the Lateral Grip (Second Maneuver).
Review the given options and select the one that correctly names the maneuver shown.
Eliminate the other options by recalling their different hand placements and purposes (e.g., Fundal grip is at the top, Pawlik's is a one-handed grasp at the bottom, and Pelvic grip involves facing the patient's feet).

Concept Tested & Keywords

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E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 16-24

E6 Obstetrics Williams p. 19-36