Leopold

Leopold’s 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: Fundal Grip To determine fetal part lying in the fundus. To determine presentation. Procedure Findings

Head is more firm, hard and Using both hands, feel for the fetal part round that moves lying in the fundus. independently of the body. Breech is less well defined that moves only in conjunction with the body. 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

Second To identify Maneuver: location of fetal Umbilical Grip back. To determine position.

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

To determine

Facing foot part of

Good attitude – if brow

the woman. fetus is at posterior position (occiput pointing towards woman’s back) . fingers will meet an Use both hands. Poor atitude – if examining the inguinalligament. obstruction on the same side as fetal back (hyperextended head) Also palpates infant’s anteroposterior position. If brow is very easily palpated.Maneuver: Pelvic Grip the degree of flexion of fetal head. palpate fetal head pressing downward about 2 inches above correspond to the side (2nd maneuver) that contained the elbows and knees. To determine attitude or habitus.

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