Leopolds Maneuver

Description: Leopold's Maneuvers is a series of hands on positions that your doctor or midwife will use to help determine the position of your baby. This is generally done at the majority of your prenatal visits in the third trimester. When your practitioner does this, be sure to ask where the baby is located. This can give you some time to start working on getting baby into the best position possible. Preparation:

1. Instruct woman to empty her bladder first. 2. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal
muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy. Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers. Procedure: First Maneuver: Fundal Grip Purpose: To determine fetal part lying in the fundus. To determine presentation.

3. 4. 5. 6.

Procedure: Using both hands, feel for the fetal part lying in the fundus. Findings: Head is more firm, hard and round that moves independently of the body. Breech is less well defined that moves only in conjunction with the body. Second Maneuver: Umbilical Grip Purpose: To identify location of fetal back. To determine position. Procedure: One hand is used to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Findings: Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation

Third Maneuver: Pawliks Grip Purpose: To determine engagement of presenting part. Procedure: Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side Findings: The presenting part is not engaged if it is not movable. It is not yet engaged if it is still movable.

Fourth Maneuver: Pelvic Grip Purpose: To determine the degree of flexion of fetal head. To determine attitude or habitus. Procedure: Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands Findings: Good attitude if brow correspond to the side (2nd maneuver) that contained the elbows and knees. Poor atitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head) Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back)

Leopolds Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated. Preparation: 1. 2. 3. 4. 5. 6. Instruct woman to empty her bladder first. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy. Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers. Purpose First Maneuver: To determine Fundal Grip fetal part lying in the fundus. To determine presentation. Procedure Findings

Using both hands, Head is more firm, hard and round feel for the fetal that moves independently of the part lying in the fundus. body. Breech is less well defined that moves only in conjunction with the body. One hand is used Fetal back is smooth, hard, and to steady the uterus on one side of the abdomen while the other hand moves slightly on a circular motion from top to the lower segment of the uterus to feel for the fetal back and small fetal resistant surface Knees and elbows of fetus feel with a number of angular nodulation

Second Maneuver: Umbilical Grip

To identify location of fetal back. To determine position.

parts. Use gentle but deep pressure. Third Maneuver: To determine Pawliks Grip engagement of presenting part. Using thumb and finger, grasp the lower portion of the abdomen above symphisis pubis, press in slightly and make gentle movements from side to side. Fourth Maneuver: Pelvic Grip To determine the Facing foot part of Good attitude if brow correspond degree of flexion of fetal head. To determine attitude or habitus. the woman, to the side (2nd maneuver) that palpate fetal head contained the elbows and knees. Poor atitude if examining fingers pressing downward about 2 will meet an obstruction on the inches above the same side as fetal back inguinal ligament. (hyperextended head) Use both hands. Also palpates infants anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards womans back) The presenting part is notengaged if it is not movable. It is not yet engaged if it is still movable.