LEOPOLD'S MANEUVERS

● Named after the gynecologist Christian Gerhard Leopold.

● Leopold's maneuvers are a systematic method of observation and palpation to
determine fetal presentation and position.
● This method of abdominal palpation is of low cost, easy to perform, and
non-invasive.
● Leopold's maneuvers are difficult to perform on obese women and women who have
polyhydramnios.

PURPOSE: To determine presentation and position of the fetus and aid in location of fetal
heart sounds.

LEOPOLD'S MANEUVER
● It is performed after 24weeks/6months (when head outline can already be palpated).

CAN ASSESS THE FOLLOWING:

● Presentation
● Attitude
● Lie
● Position
● Actual number of fetus
● Term fetal weight
● Engagement

BEFORE THE PROCEDURE

● The aim of Leopold’s Manuever is to determine the fetal presentation and position by
systematically palpating the grand abdomen

1. Wash hands
2. Explain the steps of the examination to the patient as this reduces anxiety and
enhances cooperation
3. Obtain Consent
4. The patient should be advised to void as an empty bladder promotes comfort and
allows for more productive examination and the distended bladder can obscure
faecal contour.
5. Provision of privacy
6. Prepare the equipment such as measuring tape, stethoscope or doppler transducer
and ultrasound gel
7. Position the patient supine with the head of the bed raised ot 15 degrees and a small
pillow or rolled towel placed on her right side
8. Adequate exposure of the grand abdomen from the xiphisternum to the pubis
symphysis
9. Inspect the grand abdomen
10. Stand beside the woman facing her head with your dominant hand nearest her. The
first three manoeuvre are most easily performed in this position
FIRST MANEUVER:FUNDAL GRIP

● The first maneuver aims to determine the gestational age and the fetal lie
● Gestational age can be evaluated using fundal height. or McDonald's rule.

Note : Fundal height is measured in centimeters from the pubic symphy to the top most
portion of the uterus

Fetal Lie:

Cephalic
Breech
Oblique
Transverse

SECOND MANEUVER:LATERAL GRIP/UMBILICALGRIP

● After the upper abdomen has been palpated and the form that is found is identified,
the individual performing the maneuver attempts to determine the location of the fetal
back.
● Still facing the woman, the health care provider palpates the abdomen with gentle but
also deep pressure using the palm of the hands. First the right hand remains steady
on one side of the abdomen while the left hand explores the right side of the
woman’s uterus. Thus is then repeated using the opposite side and hands.
● The fetal back will feel firm and smooth while fetal extremities should feel like small
irregularities and protrusions. The fetal back, once determined should connect with
the form found in the upper abdomen and also a mass in the maternal inlet lower
abdomen.

THIRD MANEUVER: SECOND PELVIC GRIP OR PAWLIK'S GRIP

● Modified by Karel Pawilka Czech gynecologist and obstetrician

● In the third maneuver the health care provider attempts to determine what fetal part is
lying above the inlet, or lower abd
● The individual performing the maneuver first grasps the lower portion of the abdomen
just above the pubic symphysis with the thumb and fingers of the right hand
● This maneuver should yield the opposite information and validate the findings of the
first maneuver. If the woman enters labor this is the part which will most likely come
first in a yaginal birch. If it is the hea and is not actively engaged in the birthing
process, it may be gently pushed back and forth.

FOURTH MANEUVER: LEOPOLD'S FIRST PELVIC GRIP

● The last maneuver requires that the health care provider face the woman's feet, as
he or she will attempt to locate the fetus brow.
● The fingers of both hands are moved gently down the sides of the uterus toward the
pubis. The side where there is resistance to the descent of the fingers toward the
pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it
should be on the opposite side from the fetal back. If the fetal head is extended
though, the occipur is instead felt and is located on the same side as the back
● Omit the fourth maneuver if the fetus is in a breech presentation.
● Is performed only in cephalic presentations to determine whether the fetal head is
flexed