LEOPOLD’S MANEUVER

Christian Gerhard Leopold

German Obstetrician
1846 – 1911
● To determine the position of the fetus
and its possible size.
FETAL ATTITUDE
PURPOSE

● To determine the fetal lie, presentation,

attitude and engagement.
● To aid in location of fetal heart rate.
● To aid in assessment of fetal size.
● To determine single versus multiple
gestation.

FETAL LIE Normal position of the baby

inside the mother’s womb
● Longitudinal lie, cephalic presentation,
neck flexed, engaged

FETAL PRESENTATION

BREECH PRESENTATION

PROCEDURE
● Prepare the equipment.
Rationale: Conserve time and energy
● Explain the procedure.
Rationale: To build rapport
● Instruct the client to empty her bladder.
Rationale: For the uterus be easily
palpated and get a more accurate data
● Position the woman in dorsal recumbent
FETAL ENGAGEMENT position, supine with knee flexed.
 Rationale: To relax the abdominal
muscle which helps the pregnant
woman’s body in a stable and blanched
position.
● Drape properly to maintain privacy.
Rationale: Maintain privacy, provide
comfort and lessen the client’s
embarrassment.
● Warm hands first by rubbing them
together before placing them over the
woman’s abdomen.
Rationale: To avoid startling the client
that will promote muscle contraction
and may lead to inaccurate data.
● Observe the woman’s abdomen for the
longest diameter and where the fetal
movement is apparent.
Rationale: To monitor the growth of the
baby, determine the fetal lie and know if
the growth of woman’s abdomen is
normal.
FUNDAL HEIGHT
Note: If the baby passes the age of viability (24
weeks) we can consider 1cm:1 week.
Findings: Too big for the term The mother might
be having multiple pregnancy.
Too small for the term the baby might be dead.
PERFORM THE 1ST MANEUVER
(FUNDIC GRIP)
● Stand at the foot of the client, facing
her and place both hands flat on her
Abdomen.
● Palpate the anterior surface of the
fundus to determine consistency, shape
and mobility.
Rationale: To determine the fetal
presentation
Findings: Head- hard, firm, round and moves
independently of the trunk.
Buttocks- softer, symmetric, has small bony
prominences
Extremities- nodular
PERFORM THE 2nd MANEUVER
(UMBILICAL GRIP)
● Face the client and place the palms of
each hand on either side of the
abdomen.
● Palpate the side of the uterus. Hold left
hand stationary on the left side of the
uterus while the right palpates the
opposite side of the uterus from top to
bottom. Then hold the right hand steady
and repeat palpation using the left hand
on the left side.
Rationale: To determine the position of
fetal back and fetal position
Findings: Fetal back- firm, smooth, hard and
resistant surface.
Fetal extremities- small irregularities and
protrusions
PERFORM THE 3rd MANEUVER
(PAWLIK’S GRIP)
● Gently grasp the lower portion of
the abdomen just above the
symphisis pubis between the thumb
and index finger and try to press the
thumb and finger together slightly
and make gentle movement from side
to side. Determine any movement
and whether the part is firm or soft.
Rationale: Determine what fetal part is
lying above the inlet, or lower abdomen.
Determine the fetal engagement
 Findings: movable: not yet engage
Not movable: engage

PERFORM THE 4th MANEUVER

(PELVIC GRIP)
● Facing the foot part of the
woman, palpate fetal head
pressing downward about 2
inches above the inguinal
ligament.
Rationale: Determine the degree of flexion of
the fetal head and the attitude.
Findings: Good attitude - if the brow
corresponds to the side that contains the elbows
and knees.
Poor attitude- If examining fingers will meet an
obstruction on the same side of the fetal back.

● Auscultate the heart tone using the bell

of the stethoscope or portable doppler.
Note: Bell of the steth for low pitch
sounds.
● Help the client sit.