Leopold’s Maneuvers

Leopold’s Maneuvers

Are four specific steps in palpating the uterus through the abdomen, from the fundus all the way down to the pelvic brim, named after the gynecologist Christian Gerhard Leopold.

1. First Maneuver

Question to ask ourselves: What is in the fundus?
Objective: identify the fetal pole in which the fundus is located

Facing the mother, palpate both sides of the fundus of the uterus with both hands and curve your fingers around the top of the uterus.
– Assess for shape, size, consistency and mobility.

Determine:

Fetal head:
Firm, hard, and round
– Moves independently of the rest of the body.
– Detectable by ballottement.
– Well delineated
– Longitudinal lie
Breech presentation

Breech/buttocks: softer and has bony prominences
– Fetal part: Irregular, larger or bulkier, and less firm than a head.
– Moves with the rest of the body
– Cannot be well delineated
– Longitudinal lie
Cephalic (vertex) presentation

Neither of the above is felt in the fundus
– Transverse or oblique lie

2. Second Maneuver

Question to ask ourselves: On what side is the fetal back?
Objective: identify location of the spine (back) and extremities (small parts).

Still facing the mother, place both palms on the side of the abdomen.
Hold the right hand still and with deep but gentle pressure, use the left hand to feel the back or the small parts.
– Repeat using opposite hands

Determine:

Fetal back
– Firm, convex, continuously smooth
– Resistant mass extending from the breech to the neck

Fetal small parts (hands, feet, knees, elbows)
– Small, knobby, irregular masses
– Moves or kick when pressed with examining hand
– Moves or kick when pressed with examining hand

Posterior position
Just below the umbilicus feels a saucer-like depression.

Anterior position
Above the symphysis pubis feels a bulge like a full bladder.

3. Third Maneuver

Question to ask ourselves: What is the presenting part in the lower pole?
Objective: identify what fetal part lies over the pelvic inlet.

Still facing the mother, use the thumb and fingers of one hand gently grasp the lower portion of the abdomen (just above symphysis pubis)
– Assess for shape, size, consistency and mobility

This maneuver is the same as for the first maneuver but in the opposite pole.

Pawlik grip

Gently grasp the fundus with the other hand at the same time you grasp the lower portion to compare what is in the two poles.

4. Fourth Maneuver

Question to ask ourselves: On which side is the cephalic prominence?
Objective: identify the direction and degree of flexion of the head.

Facing the mother feet, apply gently, deep pressure down the sides of the abdomen towards the symphysis pubis, using the tips of the first three fingers of each hand.
– Assess descent of the presenting part.

Determine:

If presenting part is the head
One hand is arrested sooner than the other by a hard-rounded mass (the cephalic prominence) while the other hand will descend deeply into the pelvis.

Indicates:

Cephalic prominence = Forehead
If the cephalic prominence is on the same side as the small parts
The head is well flexed and the fetus is in cephalic (vertex) presentation.

Cephalic prominence = Occiput
If the cephalic prominence is on the same side as the fetal back
The head is extended and the fetus is in face presentation.

Both hands simultaneously palpates the forehead and the occiput as a hard-rounded mass equally prominent on both sides.

Indicates:

A Sincipital or Military presentation.

If presenting part is engaged or “dipping”

Engaged:
When the cephalic prominence can’t be felt because it is out of reach in the pelvis.

Dipping:
The cephalic prominence has entered the pelvic inlet but has not yet descended.

Not engaged
It may be gently pushed back and forth in the pelvic inlet or the head may be floating.
– It may be gently pushed back and forth in the pelvic inlet or the head may be floating.

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