Leopolds Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated. Preparation: 1.

Instruct woman to empty her bladder first. 2. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. 3. Drape properly to maintain privacy. 4. Explain procedure to the patient. 5. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). 6. Use the palm for palpation not the fingers.
Purpose First Maneuver: To determine fetal part Fundal Grip lying in the fundus. To determine presentation. Procedure Findings

Using both hands, feel for the fetal part Head is more firm, hard and round that lying in the fundus. 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

Fetal back is smooth, hard, and resistant surface

other hand moves slightly on a circular Knees and elbows of fetus feel with a 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. number of angular nodulation

Third Maneuver: To determine Pawliks Grip 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 engaged if it is not movable. It is not yet engaged if it is still movable.

Fourth Maneuver: Pelvic Grip

To determine the Facing foot part of the woman, palpate Good attitude if brow corresponds to degree of flexion of fetal fetal head pressing downward about 2 the side (2nd maneuver) that contained head. inches above the inguinal ligament. To determine attitude or Use both hands. habitus. the elbows and knees. Poor atitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back)