A nurse is performing the third Leopold maneuver on a woman who is gravida 3, para 3 and is currently 37 weeks' gestation. The nurse's fingers can be pressed together below the presenting part, which is firm to the touch
What action should the nurse take regarding this assessment data?
A.
Facilitate a referral to a perinatologist.
B.
Inform the health-care provider immediately.
C.
Prepare the woman for a breech delivery.
D.
Reassure the woman and document the findings.
ANS: D
The third Leopold maneuver is performed to confirm the presentation noted in the first maneuver and to determine if the presenting part is engaged. If the presenting part moves upward so that the examiner's fingers can be pressed together, the presenting part is not engaged. In a first pregnancy, engagement usually occurs around 37 weeks' gestation; with subsequent pregnancies engagement may not occur until labor has begun. If the presenting part is firm, it is the head. If the presenting part is soft, the fetus is in the breech position. This woman is in her third pregnancy, so the lack of engagement is not abnormal. The presenting part was firm, so the baby is not breech. There is no need to inform the health-care provider immediately or facilitate a referral to a higher level of care. The nurse should reassure the woman and document the findings.
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