Leopold’s Maneuver

Leopold’s Maneuver
- It is named after the gynecologist Christian Gerhard Leopold
- Is preferably performed after 24 weeks gestation when fetal outline can be palpated
- Is a method of observation and palpation to determine fetal presentation and position
- Is a common and systematic way to determine the position of a fetus inside the woman’s
uterus
- It is also used to estimate term fetal weight
- This maneuver consist of four distinct actions, each helping to determine the position of
the uterus
- It is important to do this maneuver because it help determine the position and
presentation 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 Cesarean section is necessary)
Note:
• The health care provider should ensure that the woman has recently emptied her bladder
to promote comfort and allow more productive palpation because the fetal contour will not
be obscured by a distended bladder.
• Before performing this maneuver the health care provider should wash his hands with
warm water to aid the client’s comfort and prevent the lightening of the abdominal muscle
(cold hands can stimulate uterine contractions)
• Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal
muscles. Place a small pillow under the head for comfort

4 Steps
I Fundal Grip/ Fetal Lie
 Is perform to know what part of the baby occupies the fundus of the uterus
 How it is done:
 Stand at the foot of the client, facing her, place both hands on each
side of the upper abdomen and palpate around the fundus
 Palpate the sides of the uterus in a circular manner
 Hold the left hand stationary on the left side of the uterus while the
right hand palpates the opposite side of the uterus from top to bottom.
Then hold right hand steady and repeat palpation using the left hand
on the other side
 You would feel a hard, round, movable object if the head is in the
fundus (Vertex Presentation)
 You would feel soft and have an irregular shape and are more difficult
to move if the buttock is in the fundus (Breech Presentation)
Note: Fetal Lie is the relationship of the long axis of the mother to the
long axis of the baby
Types of Fetal Lie
 Cephalic presentation means head first. This is the normal
presentation.
 Breech presentation means the fetal butt is coming out first.
 Transverse lie means the fetus is oriented from one side of the
mother to the other and neither the head nor the butt is coming out
first.
  Compound presentation means that a fetal hand is coming out with
the fetal head.
 Shoulder presentation means that the fetal shoulder is trying to
come out first
II Umbilical Grip/ Fetal Back
 How it is done:
 Face the client and place the palms of each hand on either sides of the abdomen
 Hold the left hand stationary on the left side of the uterus while the right hand
palpates the opposite side of the uterus from top to bottom. Then hold right hand
steady and repeat palpation using the left hand on the other side. Apply firm and
even pressure.
 The fetus’s back which is a smooth, hard surface should be felt
on one side of the abdomen
 The hands, feet, elbows, and knees which are irregular knobs
and lumps will be felt on the opposite side of the abdomen
Note: If you locate the back, place stethoscope at the back because it
is where the FHT is most audible.

III Pawlick’s Grip/ Fetal Presentation

 This maneuver determines the part of the fetus at the inlet and its mobility
 To know what part of the baby lies just above the pelvic inlet
 We can also know whether the presenting part is engaged or not
 Determining whether the head is engaged:
 If the head is already descended, you will not feel the head
 If the head is not yet descended fully to the pelvic inlet, you can feel
for the shoulders of the baby.
 If the head is unengaged, you can grasp the head and you can also
move it sideways
 How to perform:
 Gently grasp the lower portion of the abdomen just above the
symphysis pubis between the thumb and the index finger, and try to
press the thumb and finger together. Determine any movement, and
whether part is firm or soft (If the presenting part moves upward, the
presenting part is not engaged (not firmly settled into pelvis). If the
part is firm, it is the head; if it is soft, then it is breech)

IV Fetal Attitude
 Used in the late stage of pregnancy to determine how far the fetus has
descended into the pelvic inlet
 To know what is the attitude of the fetus
 Should be done if fetus is in cephalic presentation
 Facing the feet of the woman, place finger 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
downward. (The fingers of one hand will slide along the uterus contour and
meet no obstruction, indicating back of the fetal neck. The other hand hand
will meet an 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 contains the elbows and knees of the fetus. If the fetus is in poor
attitude, the examining fingers will touch the hyper extended head. If the
 brow is very easily palpated (as it lies under the skin) , the fetus is probably
in a posterior position on the occiput is pointing toward the woman’s back)
Note: 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)