LEOPOLD’S MANEUVERS

LEARNING OUTCOMES

At the end of this unit, you should be able to:

• Identify the steps of Leopold’s Maneuver.
• Categorize the factors affecting the performance of the maneuvers.
• Pinpoint the nursing considerations in performing Leopold’s Maneuvers.
• Perform Leopold’s Maneuvers properly.

PRETEST

Multiple Choice
Directions: On the space provided before each item, write the letter of the correct answer.
_____1. In Leopold’s maneuver step #1 you palpated a soft., broad mass that moves with it. The
correct interpretation of this finding is:
A. Head is palpated over the fundus.
B. Back is palpated over the fundus.
C. Chin is palpated over the fundus.
D. Buttocks is palpated over the fundus.
_____2. The most common normal position of the fetus in utero is:
A. Transverse
B. Oblique
C. Vertical
D. None of the Above
_____3. In Leopold’s maneuver step # 3 you palpated a hard round movable mass at the supra
pubic area. The correct interpretation is that the mass palpated is:
A. The mass is the fetal back.
B. The mass palpated is the head.
C. The buttocks because the presentation is breech.
D. The mass palpated is the small fetal part.
_____4. Pawlick’s grip is done by facing the client and palpating using the thumb and fingers
grasping the symphysis pubis.
A. TRUE
B. FALSE
_____5. Before performing Leopold’s Maneuvers, the nurse should ask the patient to void.
A. TRUE
B. FALSE

Overview

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Ercel Q. Arellano | JRMSU – CNAHS
 Leopold’s Maneuvers
o named after the German obstetrician and gynecologist Christian Gerhard Leopold (1846–
1911).
o a common and systematic way to determine the position of a fetus inside the woman's uterus
by palpation.
o consist of four distinct actions, each helps to determine the position and lie of the fetus.
o preferably performed after 24 weeks gestation when fetal outline can be already palpated.
o It is performed to find out the following information:
o Where is the fetus lying in relation to the woman’s back?
o What is the part that is presenting at the pelvic inlet?
o Where is the fetal back located?
o Has the fetus descended into the maternal pelvis?
o What is the estimated weight of the fetus?

Factors Affecting the performance of Leopold’s Maneuvers.

 Difficult to perform in obese clients.

 Difficult to perform in clients with polyhydramnios.
 Difficult to perform in clients with full bladder.

Nursing Considerations

 Instruct mother to empty the bladder first.

 Proper positioning must be observed: Dorsal recumbent with knees slightly flexed
and put pillows under the head for comfort.
 Drape properly to maintain privacy.
 Warm hands by rubbing together.
 Use the palm not the fingers in palpation.

Performing the Maneuvers

First Maneuver (fundal grip)

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  Palpate superior surface of the fundus. Facing the
head part of the patient palpate for fetal part found in
the fundus (see figure 1). The purpose is to assess the
following:
 The size, shape, movement, and firmness of the part to determine
presentation or lie which is the relationship of the long axis (spine)
of the fetus to the long axis of the mother.
 The relationship of the location of the spine of the fetus with the
spine of the mother. Is it cephalic (vertex) or breech?

Figure 1: fundal grip

The fetal presentation refers to the part of the fetus which enters the pelvis first during
the birth process:

o Longitudinal lie (Parallel)

 Cephalic – head is presenting part; usually vertex (occiput), which
is the most favorable for birth. Head is flexed with chin on chest.
i. Face or brow – poor flexion
ii. Consistency – the head feels firmer than breech.
iii. Shape – head is round and hard; breech is less well-
defined.
iv. Mobility of palpated part – head moves independently of
the body; breech moves only in conjunction with the
body.
 Breech – buttocks or lower extremities present first.
i. Frank: thighs flexed, legs extended on anterior body
surface, buttocks presenting
ii. Full or complete: thighs and legs flexed, buttocks and feet
(baby is squatting position)
iii. Footling: one or both feet are presenting; danger of breech
birth is meconium staining
 Transverse Lie (Perpendicular) or Perpendicular lie; Shoulder
presentation.
o Shoulder: presenting part is the scapula and baby is in
horizontal or transverse position. Cesarean birth indicated.
Stand at the woman’s side facing her head then palpate using the fingers of both
examining hands and palpate gently with the fingertips to determine what part of the fetus is in the
upper poles of the uterine fundus.

Second Maneuver (umbilical grip)

The second Leopold’s maneuver involves palpation of the sides of the maternal abdomen.
The purpose is to determine location of fetal back and position or on what side is the fetus facing.
Steps to follow include:

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 1. Left hand is held stationary on the left side of the uterus while the right hand palpates
the opposite side of the uterus from top to bottom.
2. Place one hand on each side of the woman’s abdomen, aiming to capture the body of
the fetus between them.
3. Use one hand to steady the uterus and the other to palpate the fetus.
4. Look for the fetal back and determine its position. (see figure 2)
Perform again on the other side.

Figure 2: umbilical grip

5. You should feel any of the following:

a. Fetal back – feels like a smooth, resistant surface the length of the hand (or
longer) by 32 weeks of gestation.
b. Fetal knees and elbows – found on opposite side of the back. Felt as a
number of nodular angulations. The hand on the fetal arms and legs feels
irregular bumps, and also perhaps kicking if the fetus is awake and active.

Third Maneuver (lower pole or the Pawlick’s grip)

The purpose is to find out what is at the inlet of the pelvis or to determine the degree of
engagement (if the presenting part is already engaged in the pelvis). Take note that if the head is
already engaged, it will not be movable.

1. Is it firm? If yes, the head is the presenting part.

2. Is it soft? If yes, then the presenting part is breech.
3. Is it engaged? (firmly settled into the pelvis)
4. Or not engaged? (If the presenting part moves upward so that the examiner’s hands
can be pressed together, then the head is not yet engaged.
5. Use gentle but deep pressure.
6. Monitor the fetal heartbeat using the fetoscope, or, if not available, use the
stethoscope.

Using the flat palmar surfaces of the figures of both hands

and, at the start, touching the fingertips together, palpate the area just
above the symphysis pubis. This tells you whether or not the
presenting part of the fetus (head or buttocks) is descending into the
pelvic inlet. Using the right hand, grasp the symphysis pubis part
using thumb and fingers. (see figure 3)

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 If the presenting fetal part is descending, palpate its texture and firmness. If not gently
move your hands up the lower abdomen and capture the presenting part between your hands.
Grasps lower portion of the abdomen just above symphysis pubis to determine the degree of
engagement or fetal engagement.
Figure 3: Pawlick’s grip

Fourth Maneuver (pelvic grip)

The purpose is to determine the attitude or the relationship of fetal presenting part to
specific quadrant of the mother’s pelvis.
Facing the feet part as you are positioned at the head of the patient, cross your fingers
downward on both sides of the uterus approximately 2 inches above the inguinal ligaments to
determine the fetal attitude. Press inward and downward to determine antero-posterior position or
the cephalic prominence or brow. (see figure 4) If the brow is easily palpated (as if it just lies
under the skin) the fetus is probably in a posterior position (the occiput is pointing towards the
woman’s back. When the brow is on the same side as the small parts, the head will be flexed and
vertex presenting.

1. Attitude – relationship of the fetus to a part – or the degree of flexion

2. Full flexion – when the chin touches the chest.

Figure 4: pelvic grip

Procedure

LEOPOLD’s MANEUVER
DEFINITION AND PURPOSE
A method of palpating the abdomen wherein the fetal presentation, lie and position are
determined. Used to estimate fetal size, locate fetal parts, and determine presentation, position,
engagement, and attitude. Also, to check fetal heartbeat (FHB).

EQUIPMENT AND MATERIALS

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Ercel Q. Arellano | JRMSU – CNAHS
 Towel for draping
Tape measure
Stethoscope/Doppler

PROCEDURE RATIONALE
1. Explain procedure to the patient. This helps elicit cooperation.

2. Ask mother to empty her bladder. To prevent uncomfortable feeling. Uterus is easier
to palpate in an empty bladder.
3. Perform medical handwashing. To prevent transmission of microorganism.

This relaxes abdominal muscles.

4. Assist patient to assume supine position
with her knees slightly flexed (dorsal
recumbent)
Cold hands cause abdominal muscle to contract
5. Warm both hands by rubbing palms and using fingertips to palpate will tickle the
against each other and use palms not the patient.
fingers.
To determine the height of the fundus, AOG, and
6. Take the fundal height starting from the fetal size.
fundus of uterus to the symphysis pubis
using a tape measure or use the finger
breadths as means with the umbilicus and
xyphoid process as the landmark.

7. Perform Leopold’s #1 A hard, ballotable mass at the fundus means the

a. facing the patient, palpate ad determine presentation is breech.
what parts of the fetus is located on the
upper part of the uterus/fundus using the
entire surface of the fingers of both hands.

8. Proceed to Leopold’s #2
a. still facing the patient, transfer both To determine location of the fetal back and small
hands to the sides of the abdomen. Palpate fetal parts and fetal heart tone.
and determine the parts located in the right
and left side of the uterus. Apply pressure
at one side while palpating the opposite
side.

Repeat this action on the other side.

Confirm your findings by locating and
listening to the fetal heartbeat using the
stethoscope or doppler.

9. Perform Leopold’s #3
a. facing the patient’s head part, grasp To determine if the presenting part is floating or
gently the lower portion of the abdomen engaged.
which is just above the symphysis pubis
using the thumb and the fingers of one
hand to know its presenting part and how
far it has descended.

10. Perform Leopold’s #4

a. facing the foot part of the patient, place

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 fingers on both side of the uterus about the To determine fetal attitude.
inguinal ligaments. Press downward and
inward.

NOTE: APPLY FIRM, EVEN PRESSURE IN DEMONSTRATION

PALPATION FOR SUCCESSFUL RESULTS.

WATCH!!!!

LEARNING ASSESSMENT

Create a video for your return demonstration and upload thru Facebook or YouTube. Tag your
clinical instructors to grade your performance OR copy and paste the YouTube link and send it to
your respective google classroom. Please refer to performance checklist and video link for your
guide and the corresponding score for each step.

PERFORMANCE CHECKLIST

LEOPOLD’S MANEUVER WEIGH TEACHER’S REMARKS

T RATING

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Ercel Q. Arellano | JRMSU – CNAHS
 1. Introduce self and explain procedure to patient. 2

2. Wash hands. 2

3. Prepare patient by:

 Asking the patient to empty bladder. 2
 Placing the mother in dorsal recumbent 2
position.
3
4. Warm both hands by rubbing the palms against
each other.
3
5. Take fundal height and record.

6. Skillfully and correctly perform the following:

 L1 6
 L2 6
 L3 6
 L4 6

7. Take FHB/FHT accurately. 6

8. Answer CI’s question correctly. 6

_________________
CI’s Signature

_________________
Date

POST TEST

1. Multiple Choice
Directions: On the space provided before each item, write the letter of the correct answer.
_____1. In Leopold’s maneuver step #1 you palpated a soft., broad mass that moves with it. The
correct interpretation of this finding is:

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Ercel Q. Arellano | JRMSU – CNAHS
 E. Head is palpated over the fundus.
F. Back is palpated over the fundus.
G. Chin is palpated over the fundus.
H. Buttocks is palpated over the fundus.
_____2. The most common normal position of the fetus in utero is:
E. Transverse
F. Oblique
G. Vertical
H. None of the Above
_____3. In Leopold’s maneuver step # 3 you palpated a hard round movable mass at the supra
pubic area. The correct interpretation is that the mass palpated is:
E. The mass is the fetal back.
F. The mass palpated is the head.
G. The buttocks because the presentation is breech.
H. The mass palpated is the small fetal part.
_____4. Pawlick’s grip is done by facing the client and palpating using the thumb and fingers
grasping the symphysis pubis.
C. TRUE
D. FALSE
_____5. Before performing Leopold’s Maneuvers, the nurse should ask the patient to void.
C. TRUE
D. FALSE

2. Essay
As, a community health nurse, how does your knowledge and skills in performing
Leopold’s maneuvers be of help in the community. Cite its relevance and importance to the
childbearing mothers and to their respective families as a whole.

NOTE: refer to the rubrics below for your guidance.

RUBRIC

RUBRICS for ESSAY WRITING

5 – EXCELLENT 4 – VERY SATISFACTORY 3 – SATISFACTORY 2 – FAIR 1 – NEEDS
IMPROVEMENT

CRITERIA 5 4 3 2 1

1) INTRODUCTION
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 (inviting, states the main topic and previews the structure of
the paper)

2) QUALITY OF WRITING
(piece was written in an extraordinary style and voice,
highly informative and well-organized)

3) GRAMMAR, USAGE & MECHANICS

(no spelling, punctuation, or grammatical errors)

4) CONCLUSIONS
(strong and leaves the reader with a feeling that they
understand what the writer tries to point out)

TOTAL SCORE (20 points)

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Ercel Q. Arellano | JRMSU – CNAHS