LEOPOLD’S MANEUVER

Pregnant Abdomen

What is Leopolds Manuever?

It is a systematic way to determine the position of a fetus inside the uterus.

• it utilizes palpation and observation which provides information about the number of fetuses, identity of the presenting part, fetal line and attitude.

The degree of descent into the pelvis and the location of the point of maximum impulse of fetal heart rate (FHR) in relation to the woman’s abdomen.

PURPOSES

1.Systematically observing and palpating the abdomen to:

a. determine of what is in the fundus

b. evaluate the fetal back and extremitiesc. palpate the presenting part above the symphysis

d. determine the direction and degree of flexion of the head

2. The data provide the general and specific information that can be used to plan care during the ante partum and intrapartum periods.

PREPARATION:

1. Prepare the client

a. Explain the procedure to the client

Rationale:

Explanation reduces anxiety and enhances cooperation

b. Instruct the client to empty the bladder

Rationale:

Doing so promotes comfort and allows for more productive palpation because a distended bladder will obscure fetal contour.

c. Place a small pillow under the client’s head.

Rationale:

To provide comfort for the client.

d. Position the woman supine with knees slightly flexed

Rationale:

Flexing the knees relaxes the abdominal muscles

d. Drape the client properly

Rationale:

To provide client’s privacy

d. Wash your hand using warm water

Rationale:

Hand washing prevents the spread of possible infection. Using warm water aids in client’s comfort and prevents tightening of the abdominal muscles.

f. Observe the woman’s abdomen for longest diameter and where the fetal movement is apparent

Rationale:

The longest diameter (axis) is the length of the fetus, the location of activity most likely reflects the position of the feet.

IMPLEMENTATION

First maneuver

• Stand on the foot of the bed facing her, and placing both hands flat on her abdomen.

• Palpate the surface of the fundus, determine the consistency, shape and mobility.

● Expecting to palpate a soft, irregular mass in the upper quadrant of the maternal abdomen.

First Manuever

FINDINGS:

●The fetal head is round and hard, and moves independently of the trunk.

●The soft mass is the fetal buttocks, it is symmetric, and has small bony processes; unlike the head, it moves with the trunk.

Second Maneuver

● Face the client and place the palms of each hand on either side of the client’s abdomen.

● While the right hand is placed steady, palpate the opposite side of the abdomen from top to bottom using the left hand.

● Do the same to the other side of the abdomen using the right hand to palpate the side while the left palm is place steady.

Second Manuever

Findings:

● On one side of the abdomen, you will palpate round nodules; these are the fists and feet of the fetus (Kicking and movement are expected to be felt).

● The other side of the abdomen feels smooth; this is the fetus’s back

Third Manuever

● While facing the client Gently grasp the lower portion of the abdomen just above the symphysis pubis between the thumb and the third finger together (to determine the presenting part).

Determine any movement whether the part is soft or firm (also known as Pawlick’s Grip).

Third Manuever

● The unengaged is round, firm, and ballottable

● The buttocks are soft and irregular

Findings:

● Soft, presenting part at the symphysis pubis indicates Breech presentation.

Fourth Manuever

● Face the client’s feet.● Place your hand on the client’s abdomen, and point your fingers toward the mother’s feet● Then try to move the hands toward each other while applying downward pressure.

Fourth Manuever

Findings:

● If the hands move together easily, the fetal head has not descended into the maternal pelvic inlet

● If the hands do not move together and stop to resistance met, the fetal head is engaged into the pelvic inlet.

Findings

● If you palpated the buttocks in the fundus, then you should feel for the head.

● If one cannot feel the head, then it probably has descended into the pelvic inlet.