LEOPOLD’S MANEUVER

LEOPOLD’S MANEUVER Are systematic method of observation

and palpation of abdomen to determine fetal presentation, position and engagement.

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

COTRAINDICATIONS: Leopold’s maneuver

FETAL ATTITUDE

Describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other.

TYPES:1. Full or complete flexion (vertex) good attitude2. Moderate flexion (sinciput) military attitude3. Partial extension (brow)4. Complete extension (face) poor flexion

FETAL LIE

Is the relationship between the long (cephalocaudal) axis of the fetal body and the long ( cephalocaudal) axis of a woman’s body; in other words, whether the fetus is lying in a horizontal ( transverse) or a vertical (longitudinal) position.

FETAL PRESENTATION

Denotes the body part that will first contact the cervix or deliver first

TYPES:1.Cephalic presentation2.Breech presentation3.Shoulder presentation

CEPHALIC PRESENTATION:

Types

1. Vertex2. Brow3. Face4. Chin (mentum)

BREECH PRESENTATION

Types

1. Complete2. Frank3. Footling

TRANSVERSE LIE/SHOULDER PRESENTATION

Types

1. Shoulder2. Iliac crest3. Hand4. Elbow

Note: Must be born in cesarean delivery

FETAL POSITION

is the relationship of the presenting part to a specific quadrant of the woman’s pelvis.

4 landmarks:1.vertex-occiput (O)2.face-chin/mentum (M)3. breech-sacrum (Sa)4. shoulder-scapula/acromion process (A)

FETAL ENGAGEMENT

Settling of the fetal head into the pelvis

Descent of the presenting part of the fetus midpoint of the pelvis

SPECIAL CONSIDERATION

Preparation: 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. Wash hands using warm water. Explain procedure to the patient. Warms hands by rubbing together. (Cold

hands can stimulate uterine contractions). Use the palm for palpation not the fingers.

PROCEDURES:

FIRST MANUEVER: Fundal Grip

1. Palpate the uterus by feeling the upper abdomen with both hands. Head feels hard and round, freely movable and balottable.

WHAT IS THE PURPOSE? To determine fetal part lying in the fundus. To determine presentation.

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.

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SECOND MANEUVER: Umbilical Grip1. Locate the back of the fetus in relation to the

right and left side of the mother. 2. Still facing the client, place the palmar surfaces

of the both hands on either side of the abdomen and apply gentle but deep pressure.

3. If the hand of one side of the abdomen remains still to steady the uterus, a slightly circular motion with the flat surface of the fingers on the other hand can gradually palpate the opposite side from the top to the lower segment of the uterus to feel the fetal outline.

4. To palpate the other side, the functions of the hands are reversed.

5. On the fetal back, smooth, hard resistant place will be felt; side with fetal extremities will feel nodular, reflecting portions of fetal extremities

WHAT IS THE PURPOSE? To identify location of fetal back. To determine position

FINDINGS?Fetal back is smooth, hard, and resistant surfaceKnees and elbows of fetus feel with a number of

angular nodulation

THIRD MANEUVER: Pawlick’s Grip1. Gently grasp the lower portion of the abdomen,

just above the symphysis pubis between the thumb and the fingers of one hand.

2. Then press together. WHAT IS THE PURPOSE? To determine engagement of presenting part. 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 Grip1. Face the client’s feet.2. The tips of the first 3 fingers are placed on both

sides of the midline about 2 inches above the Poupart’s ligament.

3. Pressure is now made downward and the direction of the birth canal, the movable skin of the abdomen being carried downward along with the fingers.

4. The fingers of one hand meet no obstruction and be carried down ward well under Poupart’s ligament. These fingers glide over the nape of the baby’s neck.

5. The other hand however usually meets an obstruction an inch or so above the Pouparts’s ligament. This is the brow of the baby and is usually spoken of as the cephalic prominence.

What is the purpose? To determine the fetal attitude and the

degree of fetal extension into the pelvis. ! It should be done only if the fetus is in

cephalic presentation.