Leopold’s Maneuvers

Purpose

• Systematically observe and palpate the

abdomen to determine presentation
and position of the fetus and aid in
location of the fetal heart sound.
Reminders

• Explain the procedure to the woman and the rationale

for each step as it is performed.
• Ask the woman to empty her bladder.
• Have her lie in her back with her knees slightly flexed.
Place a small pillow or folded towel under one hip.
• Wash hands using warm water. Wear gloves if contact
with secretion is likely.
• Provide privacy.
First maneuver

• 1. (Fundal grip) - stand at

the foot of the woman,
facing her. Palpate the
superior surface of the
fundus. Determine
consistency, shape, and
mobility.
Rationale:

• This maneuver determines whether the fetal head

or breech is in the fundus. A head feels more firm
than the breech is round and hard and moves
independently of the body. The breech feels softer
and moves on only in conjunction with the body
Second maneuver

• 2. (Umbilical grip) - face

the woman, hold the left
hand stationary on the left
side of the uterus while you
palpate the right hand on
the opposite side of the
uterus from top to bottom.
Repeat palpation using the
opposite side.
Rationale:

• This maneuver locates the back of the

fetus. The fetal back feels like smooth,
hard, and resistant surface; the knees
and elbows of the fetus on the opposite
side feels more like a number of angular
bumps or nodules.
Third maneuver

• 3.(Pawlik’s grip) – Gently

grasp the lower portion of
the abdomen just above the
symphysis pubis between the
thumb and the fingers and
try to press the thumb and
finger together. Determine
any movement and whether
the part feels firm or soft.
Rationale:

• The maneuver determines which part of the

fetus is at the inlet and its mobility. If the
presenting part moves upward so your fingers
and thumb can be pressed together, the
presenting part is not engaged. If it is firm, it
is the head; if soft it is breech.
Fourth maneuver-

• 4. (Pelvic grip) -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 down ward.
 Rationale:
• This maneuver is only done if the fetus is in cephalic presentation
because it determines the fetal attitude and degree of fetal
extension in the pelvis. The fingers of one hand will slide along
uterine contour and meet no obstruction, indicating the back of the
neck. The other hand will meet the obstruction an inch or so above
the ligament this is the fetal brow. The position of the fetal brow
should correspond to the side of the uterus that combined the
elbows and the 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, the fetus is probably in a
posterior position.
Terms to Remember

• Fetal Presentation- Describes the fetal part

that will be first to pass through the cervix
and be delivered. Primarily determined by:
✔fetal attitude,
✔fetal lie,
✔fetal position.
Cephalic presentation

Cephalic presentation-
occurs when the head
presents first. The most
common type of
presentation.
Cephalic presentation

Vertex presentation occurs when the head is flexed sharply so that

the parietal bones or the space between the fontanels is the
presenting part.
Brow presentation occurs when the head is moderately flexed
causing the brow to enter first.
Sinsiput presentation occurs when the head is in neutral position,
neither flexed nor extended
Mentum presentation occurs when the fetal head is hyperextended
causing the face or the chin to present first.
Breech

• Breech
presentation
occurs if the
buttocks or feet
presents first.
• Complete breech occurs when the thighs of the fetus is tightly flexed
on the abdomen.
• Incomplete breech occurs when one thigh of the fetus is tightly flexed
and the other thigh is extended
• Frank breech occurs when the fetal hips are flexed but the legs are
extended and resting on the chest.
• Footling breech occurs in the absence of hip or thigh flexion of one or
both extremities such that one or both feet are the presenting part.
✔Knee presentation occurs when the presenting part is the knee.
Shoulder presentation

• Shoulder presentation
occurs when the
presenting part is the
shoulder, iliac crest,
hand or elbow. The fetus
is lying horizontally in the
pelvis
Fetal Lie

• Fetal Lie refers to the relationship of

the long axis of the fetus to the long
axis of the mother.
Longitudinal lie

• Longitudinal lie- the long axis of the

fetus is parallel to the long axis of
the mother
✔The fetus is lying vertical or top
to bottom in the uterus.
✔Nearly 99% of fetus are in
longitudinal lie at the onset of
labor.
✔Can be further classified as
cephalic or breech
Transverse lie

Transverse lie- the long axis of the fetus is

perpendicular to the long axis of the
mother.
✔The fetus is lying horizontally or side
to side in the uterus.
Oblique lie- the fetal spine and the
maternal spine are at 45 degree angles at
each other.
✔Rare occurrence, it is considered
abnormal if the fetus maintains this
position after the onset of labor.
Fetal Position

Fetal Position the relationship of the presenting part to a

specific section of the mother’s pelvis.
✔Important to determine because it can influence the
progression of labor and the possible need for surgical
intervention
✔The patient’s pelvis is divided in to four sections
based on her right and left and front and back.
✔Fetal position is described by using 3 letters
Fetal position is described by using 3 letters
The first letter designates whether the presenting part is facing to
the mothers right (R) or left (L).
Second letter is the presenting part of the fetus.
✔O-occiput
✔M-Mentum ,chin, face
✔S-sacrum
✔A- acromion
Third letter Anterior, Posterior, Transverse