Republic of the Philippines

PAMANTASAN NG LUNGSOD NG MAYNILA

(University of the City of Manila)
Intramuros, Manila

College of Nursing
Name of Student: _____________________________________ Score: ____________

Year/Section/Group/Number: _____________________________

Rate the student’s performance by using the following criteria:

4 Performed correctly and systematically according to standard with correct rationale.

3 Performed correctly, though not systematically but with correct rationale.
2 Performed correctly, not systematically, with inadequate/incorrect rationale.
1 Performed incorrectly/not done

LEOPOLD’S MANEUVERS

PURPOSE:
• Is systematic abdominal palpation to determine position, and presentation, locate
fetal parts and estimate the fetal size.
• a systematic method of observation and palpation to determine fetal position,
presentation, lie and attitude. It is preferably performed after 24 weeks gestation
when fetal outline can be palpated

Materials Needed:
• Blanket or drape
• Pillow/rolled towel
A2 P4I5 El DI
PROCEDURES RATIONALE
ASSESSMENT explain
verify
-

1. Verify the physician’s order • Verifying the physician’s order

allows the nurse to prevent error and
ensure the safety of the patient.

2. Explain the procedure to the client • Explanation reduces anxiety and

enhances cooperation.

PLANNING instruct -

position
-
drape -
wash
1. Instruct the client to empty her bladder
• An empty bladder promotes comfort
and allows for more productive
palpation because fetal contour will
not be obscured by a distended
bladder.
bladder
-
para hindi rin ma palpate yung
2. Position the woman supine with knees slightly
flexed. Place a small pillow or rolled towel under • Flexing the knees relaxes the
one side. abdominal muscles. Using a pillow or
towel tilts the uterus off the vena
cava, preventing supine hypotension
syndrome.

• Dorsal Recumbent Supine with knees

slightly flexed.

3. Drape properly to maintain privacy -

to avoid making the client

Feel embarrassed

4. Wash your hands using warm water

• Hand washing prevents the spread of
possible infection. Using warm water
aids in patient comfort and prevents
tightening of abdominal muscles
during palpation.

IMPLEMENTATION Observe Fonda / Umbilical pawliks

-

pelvic
- -
-

1. Observe the woman’s abdomen for the longest • The longest diameter (axis) is the
diameter and where fetal movement is apparent length of the fetus. The location of
activity most likely reflects the
position of the feet.

2. Perform the first maneuver or FUNDAL GRIP • This maneuver determines whether
a. Stand at the foot of the client, facing her, the fetal head or breech is in the
and place both hands flat on her abdomen. fundus. A head feels more firm than
foot OF the client , face her
, place both hands in
a breech, is round and hard, and
a triangle shape on her abdomen
moves independently of the body
(the breech feels softer and moves
and mobility
only in conjunction with the body).
100k For consistency shape ,
.

vertex

b. Palpate the superior surface of the fundus. transverse tie

complete 12 knees are Flexed )
Determine consistency, shape, and mobility. FINDINGS Breech incomplet ( I knee is Flexed)
Frank ( no knees are Flexed )

• The nurse-midwife should ascertain what

is lying at the fundus by feeling the upper
abdomen (fundus) with tips of both
hands. Generally, she will find there is a
mass, which will either be the head or
the buttocks (breech) of he fetus. The
nurse-midwife must decide which
pole of the fetus; it is by observing
three points:
Fetal tie
 • Relative consistency - the head is
harder/ firmer than the breech
• Shape - if the head, it will be round
and hard, and the transverse groove
of the neck may be felt. The breech
has no groove and usually feels more
angular
• Mobility- the head will move
independently of the trunk; but the
breech moves only in conjunction
with the body

- If the nurse-midwife feels the

head, the fetus is in breech
Fetal presentation presentation; if the nurse-midwife
feels the buttocks, it means the
fetus is in vertex presentation

3. Perform the second maneuver or UMBILICAL • This maneuver locates the back of the
GRIP fetus. The fetal back feels like a
a. Face the client and place the palms of each smooth, hard, and resistant surface;
hand on either side of the abdomen. the knees and elbows of the fetus on
the opposite side feel more like a
number of angular bumps or
nodules.
b. Palpate the sides of the uterus. Hold the left- know where the baby 's
hand stationary on the left side of the uterus back Is Facing
while the right hand palpates the opposite FINDINGS
side of the uterus from top to bottom. Then
hold the right hand steady, and repeat • Small fetal parts (knees and elbows)
palpation using the left hand on the left side. feel nodular with numerous angular
nodulations.
• Fetal back feels smooth, hard, like a
resistant surface

Fetal Position
4. Perform the third maneuver or PAWLIK’S
GRIP • This maneuver determines which
a. Gently grasp the lower portion of the part of the fetus is at the inlet and its
abdomen just above the symphysis pubis mobility. If the presenting part moves
between the thumb and index finger and try upward so your fingers and thumb
to press the thumb and finger together. can be pressed together, the
Determine any movement and whether the presenting part is not engaged (not
part is firm or soft. firmly settled into the pelvis). If the
part is firm, it is the head; if soft, then
it is the breech.
Know IF the baby 's
head Is engaged or
FINDINGS not .

• If the presenting part moves, round,

ballotable and easily displaced it is
not yet engaged. If the presenting
part is not movable felts as relatively
engagement fixed, knoblike part, it is engaged.
-
b- =
Floating • If it is firm, it must be the head. If
soft, it could be breech
+5 =
outlet

5. Perform the fourth maneuver or PELVIC GRIP
a. Facing the foot part of the client. Place
fingers on both sides of the uterus
approximately 2 inches above the inguinal
ligaments, pressing downward and inward
-
in the direction of the birth canal. Allow
fingers to be carried downward
• This maneuver is only done if the
fetus is in a cephalic presentation
because it determines fetal attitude
and degree of fetal extension into the
pelvis. The fingers of one hand will
slide along the uterine contour and
meet no obstruction, indicating the
back of the fetal neck. The other hand
will meet an obstruction an inch or so
above the ligament—this is the fetal
brow. The position of the fetal brow
should correspond to the side of the
uterus that contained the elbows and
knees of the fetus. If the fetus is in a
poor attitude, the examining fingers
will meet an obstruction on the same
side as the fetal back; that is, the
fingers will touch the hyperextended
head. If the brow is very easily
palpated (as if it lies just under the
skin), the fetus is probably in a
posterior position (the occiput is
pointing toward the woman’s back).
Fetal Position

FINDINGS
✓
• If descended deeply, only a small
portion of the fetal head will be
palpated.
Fetal attitude / degree OF Flexion • If cephalic prominence or brow or the
 baby is on the same side of the small
fetal parts, the head is flexed
• If the cephalic prominence is on the
same side of the fetal back, the head
is extended

Fundat =
presentation
umbilical =
position
Pawlik = engagement
pelvic
=
degree OF
Flexion by
attitude

EVALUATION
1. Evaluate the patient’s response to the procedure

DOCUMENTATION
1. Document observations and interventions done • Documentation provides a means for
communication and evaluation of
care and patient outcomes.
 ____________________________ _______________________________ __________________
Student’s Signature Clinical Instructor’s Date
Printed Name & Signature

PREPARED BY:

JENNIFER T. MANSING, RN, MAN

LEIZEL B. PANDI, RM, RN, MAN