Leopold’s

Maneuve
rs
"WHAT'S GOING ON IN

HERE?"
Definition of Leopold’s Maneuvers

• are a common and systematic

ways to determine the position
of a fetus inside the woman's
uterus through observation and
palpation to determine fetal
presentations and positions.
 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 shape of the maternal pelvis
can indicate whether the delivery is going to be
complicated, or whether a Cesarean section is
necessary.
• The examiner's skill and practice
in performing the maneuvers are
the primary factor in whether 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.
 Purposes
These maneuvers help identify the ff:
• Number of fetuses
• Presenting part, fetal lie and fetal attitude
• Degree of the presenting part’s
descent into the pelvis
• Expected location of the point of
maximal impulse (PMI) of the
fetal heart tones on the woman’s
abdomen.
Equipment
• Examination table
• Rolled Towel
• Top Sheet linen
• Pillow
• Basin and warm water (for hand
washing)
 Nursing Considerations:
1. Patient should empty her bladder
2. Examiner’s hand should be warm
3. Explain the procedure to the patient
4. Provide privacy
5. Position patient in dorsal recumbent.
6. Gentle yet firm touch
Nurse Alert:
• The clinician notes the presence and rate of
fetal heart sounds, as well as location for
auscultation.
• Preliminary estimates of the strength,
frequency, and duration of contractions are
also recorded.
• A helpful mnemonic device for evaluation is
the 3 Ps: powers (contraction strength,
frequency, and duration), passage (pelvic
measurements), and passenger (eg, fetal
size, position, heart rate pattern).
 Implementation with
Rationale

Preparations
1. Prepare the client  Explanation reduces anxiety and
Explain the procedure enhances cooperation

2. Instruct the client to  Doing so promotes comfort and

empty her bladder. allows for more productive
palpation because fetal contour
will not be obscured by a
distended bladder

3. Position the woman  Flexing the knees relaxes the

supine with knees abdominal muscles. Using a
slightly flexed. Place a pillow or towel tilts the uterus off
small pillow or rolled the vena cava, thus preventing
towel under one side supine hypotension syndrome.
4. Wash your hands Hand washing prevents the
using warm water spread of possible infection.
Using warm water aids in
client comfort and prevents
tightening of abdominal
muscle.

5. Observe the woman’s The longest diameter (axis) is

abdomen for longest the length of the fetus. The
diameter and where location of activity most likely
fetal movement is reflects the position of the feet.
apparent
 The First Maneuver
(fundal grip)
• Upper pole
• This maneuver determines
whether fetal head or breech is
in the fundus
• To determine what part of the
baby lies in the upper part of
the uterus.
• Palpating, with both hands, the
uterine fundus to determine
PRESENTATION ("the
presenting part"): that portion
of the fetus in closest proximity
to the birth canal, i.e., cephalic,
breech, shoulder presentations.
 1st M : 3 Questions to be asked
1. its relative consistency – the head is
harder than the breech.
2. its shape – head is firm, round and
hard. Breech is softer and feels more
angular.
3. mobility - head will move
independently of the trunk but the
breech only with the trunk.
Nurse Alert : If it is hard, round
and movable, it is likely the head
( indicating a breech
presentation) and if it is softer,
more triangular and not movable
, it is probably the buttock
( indicating a cephalic
presentation)
1. Stand at the foot of Proper positioning of hands ensures
the client, facing her, accurate findings
and place both hands
flat on her abdomen.

2. Palpate the When palpating, a head feels more

superior surface of firm than the breech. A head is round
the fundus. and hard; the breech is well defined. A
Determine head moves independently of the body;
consistency, shape, the breech moves only in conjunction
and mobility. with the body.
The Second Maneuver
(Umbilical Grip)
• Sides of maternal abdomen
• To determine in which side
of the uterus of the baby’s
back is located.
• Palpating, with both hands simultaneously, the sides of
the uterus to locate the fetal back and determine (with
about 99% certainty) POSITION: the relationship of a
given landmark on the fetus to the mother's right and left
(Therefore there are two basic positions = Rt. and Lt.).
Knowing where the back is (Rt. and Lt.) tells you the
position 99% of the time.
• Cephalic landmarks: occiput (vertex); sinciput (brow);
mentum (face).
• Breech landmark: sacrum
• Shoulder landmark: acromion process of the scapula
• LIE: the relationship of the long axis of the baby to the
long axis of the mother, i.e. longitudinal, transverse and
oblique lies.
3. Face the client and Proper positioning of hands
place the palms of each ensures accurate findings.
hand on either of the
abdomen
4. Palpate the sides of the This method is most successful to
uterus. Hold the left hand determine the direction the fetal
stationary on the left side back is facing. One hand will feel a
of the uterus while the smooth, hard, resistant surface
right hand palpates the (the back), while on the opposite
opposite side of the uterus side; number of angular
from top to bottom. Then nodulations (the knees and elbows
hold the right hand steady, of the fetus) will be felt.
and repeat palpation using
the left hand on the left
side.
• Nurse Alert : If you feel a
smooth, curved resistant plane in
one side, you have located the
back and on the other side, you
feel smaller lumps, irregular
parts, those are the the knees
and elbows of the fetus.
 The Third Maneuver
(Pawlik’s Grip)
• Lower pole
• This maneuver determines the part
of the fetus at the inlet and its
mobility.
• to determine what occupies the
lower uterine segment and to
determine whether it is engaged or
not.
• Pawlik's grip - grasping with the thumb and
fingers of one hand, the lower portion of the
maternal abdomen just above the symphysis
thus confirming the impressions of the First
Maneuver as well as providing information
• ENGAGEMENT: when the biparietal
diameter of the fetal head reaches or passes
the plane of the pelvic inlet.
• Standing to the mother's side and facing the
mother's feet
5. Facing the client, If the presenting part moves
gently grasp the lower upward so an examiner’s hands
portion of the abdomen can be pressed together, the
just above the symphysis presenting part is not engaged
pubis between the thumb (not firmly settled into the pelvis).
and index finger and try If the part is firm, it is the head;
to press the thumb and if soft, and then it is breech.
finger together.
Determine any
movement and whether
the part is firm or soft.
• Nurse Alert : The examiner grasps
the lower abdomen just above the
symphysis pubis, between the
thumb and fingers of the hand as
Pawlicks grip. If the presenting
part is not engaged, it will be
movable.
 The Fourth Maneuver
(Pelvic Grip)
• Presenting part evaluation
• This maneuver determines fetal attitude and
degree of fetal extension into the pelvis
• Should only be done if fetus is in cephalic
presentation. Information about the infant’s
antero-posterior position may also be gained
from this final maneuver.
• To determine the location of the cephalic
prominence or the brow.
• With the fingers of each hand on the sides
of the uterus suprapubicly, exerting deep
pressure in the direction of the axis of the
pelvic inlet to reinforce the impression of
engagement or lack thereof and to
determine the ATTITUDE: the
relationship of the long axis of the fetal
head to the long axis of the fetal trunk
(neck flexed, neutral or extended)
• CEPHALIC PROMINENCE: that
portion of the baby's head first
encountered with the Fourth
Maneuver; enabling the examiner to
determine which fetal landmark to
use to ultimately determine position.
• When the cephalic prominence is on
the side opposite the baby's back, the
occiput (vertex) is presenting.
• When the cephalic prominence is on
the same side as the baby's back, the
mentum (face) is presenting.
• When the cephalic prominence seems
the same on both sides, the sinciput
(brow) is presenting.
• (When there is NO cephalic
prominence, the head may be way
down in the pelvis or the breech may
be presenting.)
6. Facing the foot part of The fingers of one hand will slide
the client, place fingers on along the uterine contour and
both sides of the uterus meet no obstruction, indicating
approximately 2 inches the back of the fetal neck. The
above the inguinal other hand will meet an
ligaments, pressing obstruction an inch or so above
downward and inward in the ligament- this is the fetal brow.
the direction of the birth The position of the fetal brow
canal. Allow fingers to be should correspond to the side of
carried downward. the uterus that contained the
elbows and knees of the fetus.
 Ifthe fetus is poor attitude, the
examining finger will meet an
obstruction on the same side as
the fetal back. That is, the fingers
will touch the hyper extended
head. If the brow is very easily
palpated (as if it lies under the
skin), the fetus is probably in a
posterior position (the occiput is
pointing toward the woman’s
back).
 Nurse Caution:
• Leopold's maneuvers are intended to be
performed by health care professionals, as they
have received training and instruction in how to
perform them.
• That said, as long as care is taken not to roughly
or excessively disturb the fetus, there is no real
reason it cannot be performed at home as an
informational exercise.
• It is important to note that all findings are not
truly diagnostic, and as such ultrasound is
required to conclusively determine fetal lie.
Thank you for
listening!