LEOPOLD'S MANEUVER

 Before going to the patient room, make sure to gather all the equipment that you will need. 
 Provide privacy for the patient
 Explain the procedure to the patient and identify the patient with two identifiers.
 Good afternoon, ma'am. I am Melrhean Grace Denga-ey, your student nurse, and for verification,
ma'am, may I ask for your name and birthday? 
 So ma'am, let me explain the procedure we will be doing today. So our procedure is called Leopold's
maneuver, which means it has four maneuvers or four grips, and this is important for us to know the
fetal presentation and fetal lie of the baby inside your womb. So is that okay with you, ma'am? 
 Before we start our assessment, you can first urinate in our restroom so that there will be no
discomfort once we start our assessment. 
 Wash your hands using warm water before the procedure
 Position the woman's supine knees slightly flexed. Place a small pillow or rolled towel under one
side so that it will not cause any supine hypotension syndrome. 
 
PERFORM THE FIRST MANEUVER- Fetal presentation
 
For the first maneuver, we will assess the baby's presentation. We will be assessing if it's breech or it is
cephalic.
Breach- round, hard, and if it's movable
Cephalic- round, soft, immovable 
 
 Stand at the foot of the client, facing her, and place both hands flat on her abdomen
 Palpate the superior surface of the fundus. Determine consistency, shape, and mobility
 
PERFORM SECOND MANEUVER- Fetal back
 
In the second maneuver, we will be determining the fetal back because it is essential for us to know where
we can auscultate the fetal heartbeat so are the fetal heart rate. 
 
Normal heart rate- 120 to 160 
 
Fetal back – flat, has a resistance surface, and is hard. 
 
 Face the client and place the palms of each hand on either side of the abdomen
 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. 
 
PERFORM THE THIRD MANEUVER- Engagement
 
We will be observing here the degree of engagement. 
Here I will form an L shape on my hand, which is my index finger and thumb. 

 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. 

When you move it from side to side or move it upward to lift the head, it's movable, which means it is not
engaged. But if you move it and it's immovable, it is engaged. 
 
 
PERFORM THE FOURTH MANEUVER- Fetal attitude
 
 For the fourth maneuver, we will be facing the client's foot. 
 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 procedure somehow confirms the second maneuver, and here we will assess or determine the
degree of flexion of the fetal head.
 Remember that a well-flexed head is right opposite the fetal back.