PERFORMING LEOPOLD’S MANEUVERS

A. DEFINITION

Leopold’s maneuvers are four maneuvers employed to determine fetal position:

a) Determination of what is in the fundus
b) Evaluation of the fetal back and extremities
c) Palpation of the presenting part above the symphysis
d) Determination of the direction and degree of flexion of the head

B. PURPOSE

Systematically observing and palpating the abdomen to determine fetal presentation

and position.

C. EQUIPMENT

NONE

D. PLANNING AND IMPLEMENTATION

ACTION RATIONALE
1. Prepare the client.

a. Explain the procedure. Explanation reduces anxiety and enhances

b. Instruct the client to empty bladder.
c. Position the woman supine with
knees slightly flexed. Place a small
pillow or rolled towel under one
side.
cooperation.
Doing so promotes comfort and allows for
more productive palpation because fetal
contour will not be obscured by a distended
bladder.
Flexing the knees relaxes the abdominal
muscles. Using a pillow or towel tilts the
uterus off the vena cava, thus preventing
supine hypotension syndrome.

d. Wash your hands using warm water.
e. Observe the woman’s abdomen for
longest diameter and where fetal
movement is apparent.
2. Perform the first maneuver.
Handwashing prevents the spread of
possible infection. Using warm water aids in
client comfort and prevents tightening of
abdominal muscles.
The longest diameter (axis) is the length of
the fetus. The location of activity most likely
reflects the position of the feet.
The maneuver determines whether fetal
head or breech is in the fundus.

a. Stand at the foot of the client, facing Proper positioning of hands ensures
her and place both hands flat on her accurate findings.

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 abdomen.
b. Palpate the superior surface of the
fundus. Determine consistency,
shape, and mobility.
3. Perform the second maneuver.
a. Face the client and place the palms
of each hand on either side of the
abdomen.
b. Palpate the sides of the uterus. Hold
the left hand stationary on the left
side of the uterus while the right
hand palpates the opposite side of
the uterus from top to bottom. Then
hold the right hand steady, and
repeat palpation using the left hand
on the left side.
4. Perform the third maneuver.
a. Gently grasp the lower portion of
the abdomen just above the
symphysis pubis between the thumb
and index finger and try to press the
thumb and finger together.
Determine any movement and
whether the part is firm or soft.
5. Perform the fourth maneuver.
a. 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.
When palpating, a head feels more firm than
a breech. A head is round and hard; the
breech is less well defined. A head moves
independently of the body; the breech
moves only in conjunction with the body.
This maneuver locates the back of the fetus.
Proper positioning of hands ensures
accurate findings.
This method is most successful to determine
the direction the fetal back is facing. One
hand will feel a smooth, hard, resistant
surface (the back), while on the opposite
side, a number of angular nodulations (the
knees and elbows of the fetus) will be felt.
This maneuver determines the part of the
fetus at the inlet and its mobility.
If the presenting part moves upward so an
examiner’s hands can be pressed together,
the presenting part is not engaged (not
firmly settled into the pelvis). If the part is
firm, it is the head; if soft, then it is the
breech.
This maneuver determines fetal attitude and
degree of fetal extension into the pelvis; it
should be done only if the fetus is in a
cephalic presentation. Information about the
infant’s anteroposterior position may also be
gained from this final maneuver.
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
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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).

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 PERFORMING LEOPOLD’S MANEUVERS CHECKLIST

PROCEDURE 3 2 1 0
1. Prepare the client.
a. Explain the procedure.
b. Instruct the client to empty bladder.
c. Position the woman supine with knees slightly flexed.
Place a small pillow or rolled towel under one side.
d. Wash your hands using warm water.
e. Observe the woman’s abdomen for longest diameter
and where fetal movement is apparent.
2. Perform the first maneuver.
a. Stand at the foot of the client, facing her and place
both hands flat on her abdomen.
b. Palpate the superior surface of the fundus. Determine
consistency, shape, and mobility.
3. Perform the second maneuver.
a. Face the client and place the palms of each hand on
either side of the abdomen.
b. Palpate the sides of the uterus. Hold the left hand
stationary on the left side of the uterus while the right
hand palpates the opposite side of the uterus from top
to bottom. Then hold the right hand steady, and
repeat palpation using the left hand on the left side.
4. Perform the third maneuver.
a. Gently grasp the lower portion of the abdomen just
above the symphysis pubis between the thumb and
index finger and try to press the thumb and finger
together. Determine any movement and whether the
part is firm or soft.

5. Perform the fourth maneuver.

a. 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.
Legend:
3 - Performed in the exact manner as stated in the procedure with in-depth explanation of rationale
2- Performed in the exact manner in the procedure but the rationale is unclear and less in-depth
1 - Performed the procedure without explanation of the rationale
0 - Not performed

Rating: _____________

________________________________________ __________________________

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Signature of Clinical instructor over Printed Name Signature of Student

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