Unit 4– Palpating Fetal Presentation/Leopold’s Maneuver

Fetal presentation is a reference to the part of the fetus that is

overlying the maternal pelvic inlet. The most common relationship between
fetus and mother is the longitudinal lie, cephalic presentation. A breech fetus also
is a longitudinal lie, with the fetal buttocks as the presenting part.

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Learning Outcomes

At the end of this unit, you will 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. Back is palpated over the fundus.
B. Head 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

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 Overview

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.

Thank you for answering the test.

The next section is the content of this unit. It contains vital information of the
Leopold’s Maneuver. Please read the content.

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 Content


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)

 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

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 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:

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.

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 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)

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

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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

Thank you for reading the content.

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