Leopolds Maneuver - is preferably performed after 24 weeks gestation when fetal outline can be already palpated. Preparation: 1. 2. 3. 4. 5. 6.

Instruct woman to empty her bladder first. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy. Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers. Purpose First Maneuver: Fundal Grip To determine fetal part lying in the fundus. To determine presentation. Second Maneuver: Umbilical Grip To identify location of fetal back. To determine position. One hand is used to steady theuterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Third Maneuver: Pawliks Grip To determine engagement of presenting part. Using thumb and finger, The presenting part is notengaged if it is not Procedure Findings

Using both hands, feel for the Head is more firm, hard and round that moves fetal part lying in the fundus. independently of the body. Breech is less well defined that moves only in conjunction with the body. Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

grasp the lower portion of the movable. abdomen above symphisis It is not yet engaged if it is still movable. pubis, press in slightly and make gentle movements from side to side.

Fourth Maneuver: To determine the degree Pelvic Grip of flexion of fetal head. To determine attitude or habitus.

Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands.

Good attitude if brow correspond to the side (2nd maneuver) that contained the elbows and knees. Poor atitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back)

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Leopold's Maneuvers A. First Maneuver (Upper pole) 1. Examiner faces woman's head 2. Palpate uterine fundus 3. Determine what fetal part is at uterine fundus Second Maneuver (Sides of maternal Abdomen) 1. Examiner faces woman's head 2. Palpate with one hand on each side of Abdomen 3. Palpate fetus between two hands 4. Assess which side is spine and which extremities Third Maneuver (Lower pole) 1. Examiner faces woman's feet 2. Palpate just above symphysis pubis 3. Palpate fetal presenting part between two hands 4. Assess for Fetal Descent Fourth Maneuver (Presenting part evaluation) 1. Examiner faces woman's head 2. Apply downward pressure on uterine fundus 3. Hold presenting part between index finger and thumb 4. Assess for cephalic versus Breech Presentation I. Focus areas for abdominal palpation A. Assess Fundal Height 1. Fundal height (cm) approximates weeks of gestation a. Assess i. ii. iii. Assess i. ii. a. b. Fetal Lie Longitudinal (Normal) Transverse Oblique Fetal Presentation Breech Presentation Cephalic Presentation

b.

Vertex Presentation (Normal attitude: Full flexion) Face Presentation (Abnormal attitude: Head extends)

B. Assess Fetal Vertex Position i. Left Occiput Lateral (LOL) 40% ii. Left Occiput Anterior (LOA) 12% iii. Left Occiput Posterior (LOP) 3% iv. Right Occiput Lateral (ROL) 25% v. Right Occiput Anterior (ROA) 10% vi. Right Occiput Posterior (ROP) 10% vii. C. Assess Fetal Descent i. Is Vertex engaged?