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The prenatal check: fundal height, Leopold manoeuvres, fetal heart, fetal movements and antenatal fetal tests

  • Assessment

At each visit the nurse measures the uterus, finds the baby's position, listens to its heart, asks about movements and reads it all against the weeks.

Updated

What it is

The obstetric part of the prenatal check follows fetal growth and wellbeing. Fundal height, measured with a tape and plotted on a curve by gestational age, screens growth. The Leopold manoeuvres find the fetal lie and presentation. The fetal heart and the movements the woman feels show fetal life and health. When the pregnancy is high risk, the team may add antenatal tests such as the non-stress test or the biophysical profile. The nurse explains them and prepares the woman.

Reference values

  • Fetal heart detection: Doppler from about week 12; obstetric (Pinard) stethoscope from about week 24, sometimes from week 20 in slim women.
  • A first-time mother usually feels movements at 18–20 weeks; a woman who has given birth before, a few weeks earlier. An anterior placenta can delay it.
  • Fetuses alternate active periods (about 40 minutes) and rest (about 20 minutes).
  • Insufficient growth of fundal height detects fetal growth restriction with 56 % sensitivity and 91 % specificity.

What you need

  • A flexible, non-stretch tape measure and the fundal height curve of the perinatal card.
  • A Pinard stethoscope or a fetal Doppler, and a watch with a second hand.
  • A blood pressure device and a scale; a quiet, private space.

How to measure it (and why)

  1. Confirm gestational age from the last period or an early ultrasound — every finding is read against the weeks.
  2. Measure blood pressure and weight and plot the weight gain — detects hypertension and poor gain.
  3. Put the zero of the tape on the upper edge of the pubis and slide it between index and middle fingers to the fundus — the curves use this technique.
  4. Plot the value on the fundal height curve — normal lies between the 10th and 90th percentiles.
  5. Do the four Leopold manoeuvres: fundus, flanks, presenting part, engagement — they show lie, presentation and back.
  6. Place the stethoscope or Doppler over the anterior fetal shoulder, found by palpation — the heart is heard best there.
  7. Feel the woman's pulse while you listen — tells maternal from fetal beats.
  8. Count the fetal heart for one minute outside a contraction — gives the baseline rate.
  9. Ask about movements in the last 24 hours — a marked fall can mean fetal compromise.
  10. Record and explain the findings to the woman — she learns how her baby is and when to come back.

How to read it

  • Fundal height above the 90th percentile: rule out a dating error and think of polyhydramnios, a large fetus, twins, a mole, fibroids or obesity; high-risk assessment within 15 days.
  • Fundal height below the 10th percentile or above the 90th: obstetric ultrasound, as set by Res. 3280.
  • If palpation leaves doubt about lie or presentation, ultrasound is the method of choice.
  • Non-stress test: reactive means the heart rate rose normally, usually with movement; non-reactive leads to more tests.
  • Biophysical profile: a non-stress test with ultrasound of movement, tone, breathing and fluid; the modified profile looks only at fluid. They are used in high-risk pregnancy, diabetes or beyond 40 weeks.

Next step: when to call for help

  • Fetal heart outside 120–160 beats per minute, or not found: call the physician now.
  • Fewer than 10 movements in 12 hours, or a marked decrease: same-day assessment.
  • Fundal height outside the 10th–90th percentiles: ultrasound and high-risk referral.
  • Breech or transverse lie near term: medical assessment to plan the birth.

Test yourself

Think of the answer, then tap the question to see it.

What is the normal fetal heart rate between contractions?

From 120 to 160 beats per minute (the baseline rate).

Why does the nurse feel the woman's pulse while listening to the fetal heart?

To tell the maternal beats from the fetal beats.

What does the fourth Leopold manoeuvre assess?

How far the presenting part has engaged in the pelvis and its degree of flexion.

What does a reactive non-stress test mean?

The fetal heart rate rose normally, usually with movement.

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: Salud sexual y reproductiva: guías para el continuo de atención de la mujer y el recién nacido focalizadas en APS, 3.ª ed. (CLAP/SMR 1577) (Organización Panamericana de la Salud, CLAP/SMR, 2011); Resolución 3280 de 2018: lineamientos técnicos y operativos de la Ruta de Promoción y Mantenimiento de la Salud y de la Ruta Materno Perinatal (Ministerio de Salud y Protección Social de Colombia, 2018); Monitoring your baby before labor (MedlinePlus, U.S. National Library of Medicine, 2026).

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