I think I've promised 2 times now that we're going to talk about McDonald's measurement. Well
here it is. So, McDonald's measurement again is a way that we're able to measure the level of
the fundus and determine whether the growth is adequate during pregnancy. So this is how
we do it. So we start from the symphysis pubis which you can see in this graphic and we use
a tape measure and measure to the top of the uterus which is called the fundus. And oddly
enough, the measurement in centimeters matches with the gestational age plus or minus 2.
Ain't that amazing? And it's also proof that all of us in the United States who are not using
the metric system are probably not doing the right thing, but that's a story for another time.
So if we measure from the symphysis pubis to the top of the fundus, it will match the gestation
plus or minus 2. So for example, if a patient is 36 weeks, then they would measure anywhere
between 34 cm and 38 cm. See how that works? It's pretty cool. The other thing I want you
to think about is this. We can't use that measurement until they are 20 weeks. What do we do
before that? Well we have a couple of other landmarks. So remember 12 weeks, I talked
about just a few minutes ago that the uterus is at the level of the symphysis pubis, so right
above that pubic bone. At 20 weeks, it's at the level of the umbilicus. Okay? At 36 weeks, it's
going to be at the level of the xiphoid process. So if you don't have a tape measure, then
maybe that might be a way that you might roughly anticipate where the baby is and where
they should be at a particular gestation. So here's Leopold and Leopold is a maneuver that
we use to assess the position of the fetus. We go through position of the fetus in detail in the
5 piece of labor, but we also use it during the antepartum period in order to know whether
the baby's in a good position for labor and also where to listen to the fetal heart tones. So
there are 4 steps to the Leopold maneuver. In the 1st step, then the provider is facing the
head of the patient and they will actually palpate what's in the fundus of the uterus. So
hopefully it's a bottom which usually indicates that the baby is head down, not always but
hopefully. The 2nd maneuver, the provider is going to run their hands along the side of the
abdomen and they're actually going to feel which way the baby is facing, right or left. The 3rd
maneuver, the provider is actually going to feel right above this pubic bone and determine if
the head is actually engaged or not. If it's engaged when they wiggle, the head won't move.
If the baby is still ballotable, the head will move quite a bit. And then in the 4th maneuver,
we'll determine the amount of flexion of the fetus. So is the head tucked in or is the head
hyperextended and this has implications for labor. So that's Leopold maneuver. So, remind
me where do we listen for the fetal heart rate? Exactly, over the back and this is how we can
feel where the back is so we know where to place the fetal monitor.