How to Perform Leopold’s Maneuver

Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated.

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.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions).
6. Use the palm for palpation not the fingers.

	Purpose	Procedure	Findings
First Maneuver: Fundal Grip	To determine fetal part lying in the fundus. To determine presentation.	Using both hands, feel for the fetal part lying in the fundus.	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	To identify location of fetal back. To determine position.	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.	Fetal back is smooth, hard, and resistant surface Knees and elbows of fetus feel with a number of angular nodulation
Third Maneuver: Pawlik’s Grip	To determine 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.	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	To determine the degree of flexion of fetal head. To determine attitude or habitus.	Facing foot part of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament. Use both hands.	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 infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards woman’s back)

See Leopold’s Maneuver Demo Video

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