Notes
Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated.
Preparation:
- Instruct woman to empty her bladder first.
- Place woman in dorsal recumbent position, supine with knees flexed to relaxabdominal 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.
Steps | Purpose | Procedure | Findings |
First Maneuver: Fundal Grip | To determine fetal part lying in the fundus.To determine presentation. | Using both hands, feel for the fetal part lying in the fundus. | Head is more firm, hard and round that moves independently of the body. Breech is less well defined that moves only in conjunction with the body. |
Second Maneuver: Umbilical Grip | To identify location of fetal back. To determine position. | One hand is used to steady the uterus 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. | Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation |
Third Maneuver: Pawlik’s Grip | To determine engagement of presenting part. | Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. | The presenting part is notengaged if it is not movable.It is not yet engaged if it is still movable. |
Fourth Maneuver: Pelvic Grip | To determine the degree 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 infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position [occiput pointing towards woman’s back] |
Exam
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Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already
palpated.
- 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 | Procedure | Findings | |
First Maneuver: Fundal Grip | To determine fetal part lying in the fundus.To determine presentation. | Using both hands, feel for the fetal part lying in the fundus. | Head is more firm, hard and round that moves independently of the body. Breech is less well defined that moves only in conjunction with the body. |
Second Maneuver: Umbilical Grip | To identify location of fetal back. To determine position. | One hand is used to steady the uterus 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. | Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation |
Third Maneuver: Pawlik’s Grip | To determine engagement of presenting part. | Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. | The presenting part is not engaged if it is not movable.It is not yet engaged if it is still movable. |
Fourth Maneuver: Pelvic Grip | To determine the degree 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 infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position [occiput pointing towards woman’s back] |
See Leopold’s Maneuver Demo Video
Daisy Jane Antipuesto RN MN
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator [Level II], caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
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