Leopold's Maneuver  The abdomen should be uncovered, and most

 Are systemic method of observation and women appreciate it if the individual

palpation to determine fetal presentation performing the maneuver warms their hands
and position prior to palpation

Overview and Rationale Abdominal Palpation

 The maneuvers consist of four distinct actions,  The mother should be supine and comfortably
each helping to determine the position of the positioned with her abdomen bared
fetus  During the first three maneuvers, the examiner
 The maneuvers are important because they stands at the side of the bed that is most
help determine the position and presentation of convenient and faces the patient
the fetus, which in conjunction with correct  The examiner reverses this position and faces
assessment of the maternal pelvis can indicate her feet for the last maneuver
whether or not the delivery is going to be
complicated, or whether or not a cesarean
section is necessary Reminders
 The examiner's skills and practice in performing  Patient should empty her bladder
the maneuvers are the primary factor in  Examiner's hand should be warm
whether or not the fetal lie is correctly  Explain the procedure to the patient
ascertained, and so the maneuvers are not truly  Provide client's privacy
diagnostic.  Position patient in dorsal recumbent
 Actual position can only be determined by
ultrasound performed by a competent
FOUR MANEUVER’S EMPLOYED TO DETERMINE FETAL
technician or professional
POSITION

- Determine of what is in the fundus

- Evaluation of the fetal back and extremities
- Palpation of the presenting part above the
symphysis
- Determination of the direction and degree of
flexion of the head

PROCEDURE

First Maneuver (Fundal Grip)

Difficulties in Performing Maneuvers
 When client is obese
 When client has hydramnios
 The palpation can be uncomfortable if woman
is not relaxed and adequately positioned

Aids in Performing the Maneuvers

 The health care provider should ensure that the
woman has recently emptied the bladder - Face the patient and warm your hands
 If not she may need to have a straight urinary - Place your hands on the patient’s abdomen
catheter inserted to empty it if she is unable to - Determine what fetal part is at uterine fundus
micturate herself - Curl your fingers around the fundus
 The woman should lay on her back with her - When the fetus is in the vertex position (head
shoulders raised slightly on a pillow and her first) buttocks should feel irregular shape and
knees drawn up a little firm
 - When the fetus is in breech position, the head o If the fetus is in the breech position,
should feel hard round and movable you’ll also feel a less distinct mass,
which could be the feet or knees
Second Maneuver (Umbilical Grip)
o Identifies the presenting part to
determine the presentation and it’s
mobility to determine engagement

Fourth Maneuver (Pelvic Grip)

- Move your hands down the side of the

abdomen
- Applying gentle pressure
o If the fetus is in vertex position, you’ll
feel a smooth, hard surface on one side
– the fetal back
- The fourth maneuver can determine flexion or
- Opposite, you’ll feel lumps and knobs (the
extension of the fetal head and neck
knees, hands, feet, and elbow)
- Place your hands on both sides of the lower
o If the fetus is in the breech position,
abdomen
you may not feel the back at all
- Apply gentle pressure with your fingers as you
o Identifies and describes the fetal parts
slide your hands downward, toward the
contained on each side of the uterus
symphysis pubis
o Locates for the position of the fetal
- If the head is in the presenting fetal part (rather
back and auscultate for the fetal heart
than the feet or a shoulder), one of your hands
beat
is stopped by the cephalic prominence
Third Maneuver (Pawlick’s Grip) - The other hand descends unobstructed more
deeply
- If the fetus is in the vertex position, you’ll feel
the cephalic prominence on the same side as
the small parts; if it’s in the face position the
same side as back
- If the fetus is engaged, you won’t be able to feel
the cephalic prominence
- Determines the fetal attitude

STATION

- Spread apart your thumb and fingers of one

hand
- Place them just above the patient’s symphysis
pubis
- Bring your hand together
o If the fetus is in the vertex and has
descended, you’ll feel a less distinct
mass
 - This picture shows the transverse lie of the
fetus. This is a problem with a term baby and
labor approaching

OBLIQUE

- This is picture of an oblique lie of the fetus and

is a problem in a term pregnancy

CAUTIONS

- Leopold’s maneuver are intended to b e

performed by health care professionals
- Fetal station is the position of the fetal
- As long as care is taken not to roughly or
presenting part and its descent into the pelvis.
excessively disturb the fetus, there is no reason
How far has the fetus descended. The Ischial
it cannot be performed at home as an
Spines of the maternal pelvis are used to
information exercise
describe station 0
- It is important to note that all findings are not
FETAL LIE truly diagnostic, and as such ultrasound is
required to conclusively determine fetal lie

- the fetal lie is described by the relationship of

the long axis of the fetus to the long axis of the
mother. This is a vertical lie. It is the most
common fetal lie

TRANSVERSE