How to Perform Leopold’s Maneuver

1. Provide privacy to the client.

2. Expose the abdomen of the client.
3. Locate the fundus and measure the height from the symphysis pubis to the top of
the fundus.
4. Record the data or findings.
First Maneuver (Fundal Grip)
5. Palpate the fundus of the uterus at the upper abdomen with both hands. The
head feels hard and round, firm, freely movable and palpable by ballottement.
Breech feels less regular and softer.
Second Maneuver (Umbilical Grip)
6. Locate the back of the fetus in relation to the right and left sides of the client.
Apply deep pressure with the palm of your hands to palpate the abdomen gently.
Placing the right hand on one side of the patient’s abdomen while using the left
hand to explore the woman’s uterus on the right side. Repeat this step on the
opposite side using the opposite hand. The fetal back is smooth and firm. The
extremities of the fetus should feel like protrusions and small irregularities. The
back should connect with the form felt in the lower (maternal inlet) and upper
abdomen.
Third Maneuver (Pawlick’s Grip)
7. Gently grasp the lower portion of the uterus just above the symphysis pubis
between the thumb and the fingers of one hand.
8. Press slightly. If the head is the presenting part and not engaged, a movable
body is felt.
Fourth Maneuver (Pelvic Grip)
9. Locate the fetus’ brow. Gently move the fingers on both hands toward the pubis
by sliding the hands over the sides of the patient’s uterus, and the side where the
greatest resistance to the descending fingers is the location of the brow. If the
cephalic prominence is found on the same side as the small parts, the head with
flexed and vertex is presenting. If the cephalic prominence is on the same side
as the head, the presenting part is extended and the face is presenting.
Fetal Heart Sound
 If using a stethoscope.
1. Place directly the diaphragm on the abdomen of the client and listen for
the fetal heart sound.
 If using a doppler.
1. Apply first a water-soluble gel.
2. Turn on the doppler device fetal.
 3. Place the probe on the abdomen and listen for the fetal heart sound for 1
whole minute.
4. Adjust the volume, as needed.
5. Compare the audible heart sound to the client’s pulse.

Third Stage of Labor – Placental Delivery

1. Observe for signs of uterine separation.
a. Sudden gush of blood.
b. Lengthening of the cord.
c. Fundus of the uterus rises, becomes firm and globular.
2. Deliver the placenta carefully and completely. Perform Brandt-Andrews
maneuver to prevent uterine inversion. A continuous traction of the cord and
counter traction of the pelvic area specifically the uterus.
3. Check the completeness of the placenta.

Care for the Neonate in the Delivery Room

1. Place the neonate at the resuscitation table
2. Wipe the infant
3. Measure the head circumference by placing a tape measure around the infant’s
head just above the eyebrows and around the most prominent portion of the back
of the head.
4. Measure the chest circumference by placing a tape measure around the infant’s
nipple line.
5. Measure the abdominal circumference by placing the tape measure around the
abdomen of the infant at the level of the umbilicus.
6. Measure the height of the infant by putting the tape measure on the top of the
infant’s head, straightening the body of the infant, and marking the end of the
infant’s foot at the measuring tape.
7. Measure the weight of the infant by lying them without any clothing yet on the
infant scale. Always keep a protective hand over an infant on an infant scale
because to avoid danger of them falling.
8. Apply antibiotic ointment called azithromycin to the infant’s eyes
9. Put cap.
10. Grab an antiseptic wipe and wipe on anterolateral thigh of the neonate.
11. Inject Vitamin K intramuscularly, specifically at the bulkiest part of the vastus
lateralis thigh muscle of the neonate. This will help in blood clotting to prevent
severe bleeding. Infants do not get enough vitamin K from their mothers during
pregnancy, or when they are breast feeding. Without vitamin K, they are at risk of
getting a rare disorder called ‘vitamin K deficiency bleeding’ (VKDB).
12. Grab another antiseptic wipe and wipe on the opposite anterolateral thigh of the
neonate.
13. Inject Vitamin hepatitis B vaccine intramuscularly too at the bulkiest part of the
vastus lateralis thigh muscle of the neonate. This will protect them from exposure
to hepatitis B virus since they are not able to fight off this virus.