LEOPOLDS’ MANEUVERLEOPOLDS’ MANEUVER

At the end of the lecture, the students will be able to:–Identify the steps in performing

Leopolds’ Maneuver.–Identify Nursing considerations in

performing Leopolds’ maneuver.

• are a common and systematic way to determine the position of a fetus inside the woman's uterus.

• are important because they help determine the position and presentation of the fetus.

• Named after the gynecologist Christian Gerhard Leopold.

• Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated.

• The maneuvers are not truly diagnostic.

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

• Difficult to perform in obese women.

• Women with hydramios.

• Women with full bladder.

Nursing Considerations

• Instruct woman to empty her bladder first. • Place woman in dorsal recumbent position,

supine with knees slightly flexed. Place a small pillow under the head for comfort.

• Drape properly to maintain privacy. • Explain procedure to the patient. • Warm hands by rubbing together. • Use the palm for palpation not the fingers.

• While facing the woman, palpate the woman's upper abdomen with both hands.

• Often determine the size, consistency, shape, and mobility of the form that is felt.

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

• The buttocks feels softer, is symmetric, and has small bony prominences; it moves with the trunk.

What lies at the fundus?What lies at the fundus?

• The maneuver attempts to determine the location of the fetal back.

• Facing the woman, the health care provider palpates each side of the abdomen with gentle but deep pressure using the tips of his or her hands.

• The fetal back is firm and smooth, hard, resistant surface.

• Fetal extremities feels like small irregularities and protrusions.

Where is the fetal back?Where is the fetal back?

• Determine what fetal part is lying above the inlet, or lower abdomen.

• The individual performing the maneuver first grasps the lower portion of the abdomen just above the symphysis pubis with the thumb and fingers of the right hand.

What is in the inlet?What is in the inlet?

• The health care provider faces the woman's feet, as he or she will attempt to locate the fetus' brow.

• To determine the degree of flexion of the fetal head.

• The fingers of both hands are moved gently down the sides of the uterus towards the pubis.

What is the attitude?

• Good attitude

– If brow correspond to the side that contained the elbows and knees.

• Poor attitude

– If examining fingers will meet an obstruction on the same side as fetal back.

Thank you all !!!