LEOPOLD’S

MANEUVER
BENEMILE ISABELLE
DR ROTATION
 THE LEOPOLD MANEUVERS
Named after the German obstetrician and gynecologist Christian
Gerhard Leopold (1846–1911), are part of the physical examination of
pregnant women. Four classical 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. Leopold's Maneuver is
preferably performed after 24 weeks gestation when fetal outline can
be already palpated.
FOUR
TECHNIQUE
 E U V E R
S T M A N )
F I R A L G R I P
( F U N D
 1.THE FIRST MANEUVER
( FUNDAL GRIP)
- Aims to determine the gestational age and the fetal lie.
A. assesses the uterine fundus to determine its height and which fetal pole—that is,
cephalic or podalic—occupies the fundus.
B. The uterine contour is outlined by the examiner, placing both of his or her hands
on each upper quadrant of the patient's abdomen facing the maternal xiphoid
cartilage.
C. The ulnar border of each hand is in contact with the abdominal wall, and the
opposite fingers are touching each other.
D. Using the fingertips, the fundus is gently palpated to identify which fetal part is
present in the upper pole (fundus) of the uterus.
 1.THE FIRST MANEUVER
( FUNDAL GRIP)

• Breech - gives the sensation of a large, nodular mass, and its surface is
uneven, non-ballotable, and not very mobile.
• Head - hard and round with smooth surface of uniform consistency, is
very mobile and ballotable.
 E U V E R
N D M A N P )
SE C O A L G R I
M B I L I C
(U
 2.THE SECOND MANEUVER
( UMBILICAL GRIP)
- Involves palpation of the lateral uterine surfaces.

A. Still facing the maternal xiphoid cartilage, both hands slide down from the uterine
fundus towards the lateral uterine walls.
B. The clinician's hands are placed flat and parallel to each other along the abdominal
wall at the level of the umbilicus. It allows establishing if the fetus is in a longitudinal,
transverse, or oblique situation, and to determine the position
of the back and small parts.

C. The operator places the two flat hands sideways to the uterus and tries to bring them
closer to the midline. In the approach maneuvers, the operator's hands are one on the back
of the fetus and one on the small parts, which give different tactile sensations.
 2.THE SECOND MANEUVER
( UMBILICAL GRIP)

• The approach is possible when the fetus is in a longitudinal position

regardless of the type of presentation, while it is not possible when the
situation is transverse or oblique.
• If the identification of the fetal back proves to be difficult, the provider can
perform the following maneuvers:

A simple adjustment involves alternating two hand palpation of lateral uterine

surfaces. By placing the right hand steady on one side of the abdomen while using
the palm of the left hand, the right side of the gravid uterus is palpated gently. This
is then repeated using the opposite side.
 E U V E R
R D M A N P )
T H I K ’ S G R I
(PAW L I
 2.THE THIRD MANEUVER
(PAWLIK'S GRIP)
- This maneuver aids in confirmation of fetal presentation.

- The first Pawlík’s grip, sometimes called the first pelvic grip, helps to define which
presenting part of the fetus is situated in hypogastrium.
A. Using the thumb and fingers of the right-hand close above the pubic symphysis, the
presenting part is grasped at the lower portion of the abdomen and draws the thumb and finger
near to clasp the lower uterine segment including its contents.

- In the second Pawlík’s grip,

B. The clinician carries on by sliding the hand upward to determine the cervical groove: if the
mass moves, the presenting part is not engaged.
 E U V E R
T H M A N
F O U R C G R I P )
(PEL V I
 2.THE FOURTH MANEUVER
(PELVIC GRIP)
- Resembles the first maneuver; however, the examiner faces towards the maternal
pelvis.

A. This maneuver involves the examiner placing the palms of both hands on either
side of the lower abdomen, with the tips of the fingers facing downward toward the
pelvic inlet.
B. The fingertips of each hand are used to apply deep pressure from the outside to the
inside and in a craniocaudal direction along the lower contour of the uterus towards
the birth canal.
C. It is possible to identify the characteristics of the part presented and confirm the
findings detected with the third Leopold maneuver. The fingers of both hands move
gently along the sides of the uterus towards the pubis.
⚬ The side where there is resistance to the descent of the fingers towards the
pubis is larger is where the forehead is located.
 CONCLUSION
It is important to perform Leopold’Maneuver because it
can help determine the position and lie of the fetus,
which in conjunction with correct assessment of the
shape of the maternal pelvis can indicate whether the
delivery is going to be complicated, or whether a
caesarean section is necessary.
Reference:
https://www.ncbi.nlm.nih.gov/books/NBK560814/