Leopold’s Maneuver

Learning Objective

Understand Leopold’s Maneuver , Purpose and Outcome

Leopold’s Maneuver

• Are used to determine the orientation of the fetus through abdominal palpation

Overview and Rationale

• The maneuvers consist of four distinct actions, each helping to determine the position of the fetus.

• The maneuvers are important because they help determine the position and presentation of the fetus, which in conjunction with correct assessment of the maternal pelvis can indicate whether or not the delivery is going to be complicated, or whether on not a cesarean section is necessary.

• The examiner’s skills and practice in performing the maneuvers are the primary factor in whether or not the fetal lie is correctly ascertained, and so the maneuvers are not truly diagnostic.

• Actual position can only be determined by ultrasound performed by a competent technician or professional.

Difficulties in Performing Maneuvers

• When client is obese• When client has hydramnios• The palpation can be

uncomfortable if woman is not relaxed and adequately position.

Aid in Performing the Maneuvers

• The health care provider should ensure that the woman has recently emptied the bladder

• If not she may need to have a straight urinary catheter inserted to empty it if she is unable to micturate herself.

• The woman should lay on her back with her shoulders raised slightly on a pillow and her knees drawn up a little

• The abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation.

Abdominal Palpation• The mother should be supine and

comfortably positioned with her abdomen bared.

• During the first three maneuvers, the examiner stands at the side of the bed that is most convenient and faces the patient

• The examiner reverses this position and faces her feet for the last maneuver.

Reminder• Patient should empty her bladder• Examiner’s hand should be warm • Explain the procedure to the

patient• Provide client’s privacy• Position patient in dorsal

recumbent

Four maneuver's employed to determine

fetal position: • determination 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.

ProcedureProcedurePrepared by:

CYNTHIA DELA CRUZ

First Maneuver• face the patient and warm your hands • Place your hands on the patient’s

abdomen• Determine what fetal part is at uterine

fundus• Curl your fingers around the fundus• When the fetus is in the vertex position

(head first) buttocks should feel irregular shape and firm

• When the fetus is in breech position, the head should feel hard, round and movable

Second Maneuver• Move your hands down the side of the

abdomen• Applying gentle pressure If the fetus is in vertex position, you’ll feel

a smooth, hard surface on one side- the fetal back

• Opposite, you’ll feel lumps and knobs- the knees, hands, feet, and elbow

If the fetus is in the breech position, you may not feel the back at all

Third Maneuver• Spread apart your thumb and fingers of

one hand.• Place them just above the patient’s

symphysis pubis• Bring your hand together If the fetus is in the vertex and has

descended, you’ll feel a less distinct mass If the fetus is in the breech position, you’ll

also feel a less distinct mass, which could be the feet or knees.

Fourth Maneuver• The fourth maneuver can determine flexion or

extension of the fetal head and neck• Place your hands on both sides of the lower abdomen• Apply gentle pressure with your fingers as you slide

your hands downward, toward the symphysis pubis• If the head is in the presenting fetal part (rather than

the feet or a shoulder), one of your hands is stopped by the cephalic prominence.

• 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.

Station• Fetal station is the

position of the fetal presenting part and its descent into the pelvis...how far has the fetus descended...the ischial spines of the maternal pelvis are used to describe 0 station.

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• This picture

shows the transverse lie of the fetus.  This is a problem with a term baby and labor approaching

Oblique• This is a picture

of an oblique lie of the fetus and is a problem in a term pregnancy

Cautions • Leopold’s maneuver are intended

to be performed by health care professionals

• As long as care is taken not to roughly or excessively disturb the fetus, there is no reason it cannot be performed at home as an information exercise.

• It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine fetal lie

ENDThank You and God

Bless