Leopold’s Maneuver

- Systematic palpation of the gravid abdomen.

- Preferably performed after 24 weeks gestation when fetal outline can be already palpated.

Purpose:
1. To determine the engagement.
2. To determine the presentation.
3. To determine the position.
4. To determine if more than one fetus is in utero.
5. To enable the nurse to locate the area where FHT is best heard.

Preparation:
* Explain the procedure
* 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.
First Maneuver
- Palpate the superior surface of the abdomen (Fundus) with the finger tips.
 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
- Palpate the sides of the abdomen.
 To determine where the fetal back is located in relation to the Left or Right side of mother’s
abdomen.
 The fetal back is the area where FHT is best heard.
- With one hand steady on one side, make a slightly circular motion with fingers of the other hand on
the other side starting from the top going towards the lower segment of the uterus. Use gentle but
deep pressure.
 To keep the uterus steady.
 To feel for the fetal back and small fetal parts
 Fetal back is smooth, hard, and resistant surface
 Knees and elbows of fetus feel with a number of angular nodulation

Third Maneuver
- 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.
 To determine engagement of presenting part.
 The presenting part is engaged if it is not movable. It is not yet engaged if it is still movable.

Fourth Maneuver
- Facing foot part of the woman, place tips of the 1st 3 fingers on both sides of the lower uterus about
2 inches above the inguinal region.
- Palpate fetal head pressing downward and inward in the direction of the birth canal.
- Use both hands
 To determine the degree of flexion of fetal head.
 To determine attitude or habitus.
 Good attitude - if brow, correspond to the side (2nd maneuver) that contained the elbows
and knees.
 Poor attitude - 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)
- Place the patient on comfortable position.
- Record the findings correctly, interpret and relay findings to mother.