Leopold Maneuvers: are used to palpate the gravid uterus systematically.

This method of
abdominal palpation is of low cost, easy to perform, and non-invasive. it is used to determine the
position, presentation, and engagement of the fetus in utero. The following are techniques used
in the palpation of abdomen.

Fundal Grip

This maneuver helps to determine the pole of the fetus (cephalic or podalic) which occupies the
uterine fundus. The examiner stands on the right and places both hands with the palms down and
fingers touching each other over the fundus and the fundus is palpated between these two hands.
If it is a breech, it will appear soft and regular and cannot be independently moved from the
body. If it is head, it is rounded, hard and can be moved independently. In transverse lie, no part
of the fetus will be found at the fundus.

Umbilical Grip
This helps to identify the side occupied by the back and limbs. The two hands are brought down
and placed on either side of the uterus, at the level of umbilicus. Steady the uterine wall with one
hand and palpate with the other to find out the side of the back which is firm and uniformly
curved. The nodular limb buds will be on the opposite side. In transverse lie the head will be felt
on one side and the breech on the opposite pole.

First Pelvic Grip (Pawlik’s grip)

This is done to identify the part of the fetus which occupies the lower pole of the uterus. Place
the right palm on the lower pole of the uterus and grip the part between thumb and fingers. Try to
move the part of the fetus occupying the lower pole. If it is head, it is hard, rounded and may be
ballotable. If breech, it is soft, irregular and not ballotable. In transverse lie lower pole is empty.

Second Pelvic Grip

This is done to assess the attitude of the head and to know whether the head is engaged. The
examiner stands facing the feet of the woman. The fingers of both hands are placed on either side
of the lower part of the uterus and brought down till the head is felt by one hand. That hand is
kept steady and the other hand is lowered till the opposite pole of the head is felt. The portion of
the head felt on the side of the back is occiput and the opposite is sinciput. The levels of occiput
and sinciput and their relationship are noted. If occiput is at a lower level than sinciput, the head
is flexed. If both are at same level, the head is deflexed. If sinciput is at a lower level than the
occiput, the head is extended. If the head is engaged only sinciput will be felt since the occiput
would have entered the pelvic brim. If both occiput and sinciput are felt head has not engaged,
i.e., it is floating.

In summary