PERFORMANCE CHECKLIST

LEOPOLD’S MANEUVER AND FETAL ASSESSMENT

Name:____________________________________ Grade:__________

Year and Section:__________________________ Date:____________

Learning Outcome #1. Assess the mother using specific methods (Leopold’s Maneuver and Fetal
Assessment) and tools to address existing health needs during the antepartum stage.

Criteria:

Score Description
1 The student performed the item completely and correctly.
0 The student performed the skill incompletely, and incorrectly, and incurred gross
mistakes or did not perform the item at all.

ITEMS HPS SCORE REMARKS

Preparation
1) Washes hands using warm water. Ensure warm 1
hands during the procedure.
2) Gathers equipment. 1
3) Identifies the correct patient, introduce yourself 1
and establish rapport.
4) Explains the procedure and rationale to the 1
patient.
5) Obtains informed consent. 1
6) Instructs the patient to void to empty bladder. 1
7) Provides privacy. Prevent unnecessary exposure. 1
Procedure
8) Stands at the foot part of the patient and observe 1
the abdomen as to which is to be the longest
diameter and where fetal movement is apparent.
9) Positions the patient supine with knees slightly 1
flexed. Place a small pillow or rolled towel under
her left side.
10) Obtains the fundal height. 1
11) Performs the first maneuver. 1
12) Performs the second maneuver. 1
13) Repeats the second maneuver on the opposite
side.
14) Performs third maneuver. 1
15) Performs fourth maneuver: (Note: do not proceed 1
to the last maneuver if the presenting part is
breech).
16) Locates the site for obtaining FHT. 1
17) Places the bell of the stethoscope to the site. 1
18) Auscultates fetal heart sounds. 1
19) Places the patient in a comfortable position. 1
20) Washes hands. 1
21) Documents pertinent findings. 1
 TOTAL 21

Student:________________________ Date:___________

Instructor:______________________ Date:__________