LEOPOLD’S MANEUVER

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LEOPOLD’S MANEUVER IS PREFERABLY PERFORMED AFTER 24 WEEKS GESTATION WHEN FETAL OUTLINE CAN BE ALREADY PALPATED. THESE ARE FOUR SPECIFIC STEPS IN PALPATING THE
UTERUS THROUGH THE ABDOMEN IN ORDER TO DETERMINE THE LIE AND PRESENTATION OF THE FETUS.

PREPARATION:
1. Instruct the woman to empty her bladder first.
2. Place the woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head fro comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warm hands by rubbing together. (Cold hands can stimulate uterine contractions).
6. use the palm for palpation not the fingers.

STEPS:
1. The top of the uterus (fundus) is felt (palpated) to establish which end of the fetus (fetal pole) is in the upper part of the uterus. If either the head or breech (buttocks) of the fetus are in
the fundus then the fetus is in vertical lie. Otherwise the fetus is most likely in transverse lie.
2. Firm pressure is applied to the sides of the abdomen to establish the location of the spine and extremities (small parts).
3. Using the thumb and fingers of one hand the lower abdomen is grasped just above the pubic symphysis to establish if the presenting part is engaged. If not engaged a movable body part
will be felt. The presenting part is the part of the fetus that is felt to be in closest proximity to the birth canal.
4. Facing the maternal feet the tips of the fingers of each hand are used to apply deep pressure in the direction of the axis of the pelvic outlet. If the head presents, one hand is arrested
sooner than the other by a rounded body (the cephalic prominence) while the other hand descends deeply into the pelvis. If the cephalic prominence is on the same side as the small
parts, then the fetus is in vertex presentation. If the cephalic prominence is on the same side as the back , then the head is extended and the fetus is in face presentation.

REFERENCES:

http://perinatology.com/Reference/glossary/L/Leopolds.htm?fbclid=IwAR3jYwJ6HrA6mIubh_20d37uBZ2hwZmVlm53hzh6oXR25df33gN86zDD6BE#:~:text=Leopold's%20maneuvers%20are%20f
our%20specific,upper%20part%20of%20the%20uterus

https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/performing-leopolds-maneuver/?fbclid=IwAR3n6maa3NGyxNITcgl4Fo8BUD6AHRErSMzEdWUB-
4nzMhc3taXlW9ShNuM

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7 CARDINAL MOVEMENTS OF LABOR

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Labor is a physical and emotional event for the laboring woman. For the infant, however, there are many positional changes that assist the baby in the passage through the birth canal. Because
of the resistance met by the baby, positional changes are specific, deliberate and precise as they allow the smallest diameter of the baby to pass through a corresponding diameter of the
woman's pelvic structure. Neither care providers nor the laboring woman is directly responsible for these position changes. The baby is the one responsible for these position changes ~ the
cardinal movements.

A. Engagement or the entering of the biparietal diameter (measuring ear tip to ear tip across the top of the baby's head) into the pelvic inlet.

B. Descent
The baby's head moves deep into the pelvic cavity and is commonly called lightening. The baby's head becomes markedly molded when these distances are closely the same. When the
occiput is at the level of the ischial spines, it can be assumed that the biparietal diameter is engaged and then descends into the pelvic inlet.

C. Flexion
This movement occurs during descent and is brought about by the resistance felt by the baby's head against the soft tissues of the pelvis. The resistance brings about a flexion in the
baby's head so that the chin meets the chest. The smallest diameter of the baby's head (or suboccipitobregmatic plane) presents into the pelvis.

D. Internal rotation
As the head reaches the pelvic floor, it typically rotates to accommodate for the change in diameters of the pelvis. At the pelvic inlet, the diameter of the pelvis is widest from right to
left. At the pelvic outlet, the diameter is widest from front to back. So the baby must move from a sideways position to one where the sagittal suture is in the anteroposterior diameter
of the outlet (where the face of the baby is against the back of the laboring woman and the back of the baby's head is against the front of the pelvis). If anterior rotation does not occur,
the occiput (or head) rotates to the occipitoposterior position. The ocipitoposterior position is also called persistent occipitoposterior and is the common cause for true back labor.

E. Extension
After internal rotation is complete and the head passes through the pelvis at the nape of the neck, a rest occurs as the neck is under the pubic arch. Extension occurs as the head, face
and chin are born.

F. External rotation
After the head of the baby is born, there is a slight pause in the action of labor. During this pause, the baby must rotate so that his/her face moves from face-down to facing either of the
laboring woman's inner thighs. This movement, also called restitution, is necessary as the shoulders must fit around and under the pubic arch.

It is at this point that shoulder dystocia may be identified. Shoulder dystocia occurs when the baby's shoulders are halted at the pelvic outlet due to inadequate space through which to
pass. Mother's birthing babies who are identified as macrosomatic (in excess of 9.9 lbs.) are more likely to experience shoulder dystocia. Additionally, 15-30% of macrosomatic babies
experiencing shoulder dystocia sustain some injury to the brachial plexus. Most of these injuries (80%) resolve by the baby's first birthday.

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 Commonly, the McRobert's technique is used to resolve shoulder dystocia. This technique involves a sharp flexing of the maternal thighs against the maternal abdomen to reduce the
angle between the sacrum and the spine.

G. Expulsion
Almost immediately after external rotation, the anterior shoulder moves out from under the pubic bone (or symphisis pubis). The perineum becomes distended by the posterior
shoulder, which is then also born. The rest of the baby's body is then born, with an upward motion of the baby's body by the care provider.

REFERENCES:

http://www.kastanis.org/uploads/0000/0013/CardinalMovements-1.pdf?fbclid=IwAR1nj5e1fyuEDxKEX-08dfs-60JkIK--GsmSRDnNA56ZHjelij7tVvbMJXY

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