NIRO, IRISH PAULENE M.
MCN 107 - LECTURE
BSN 2 - LYDIA HALL
LEOPOLD MANEUVERS
➢ Leopold’s maneuvers are a ➢ The purpose of Leopold maneuvers
systematic four-step assessment of
the maternal abdomen by
performing external palpation of the
uterus through the abdominal wall.
➢ PALPATION - main or specific
nursing assessment, and can help to
determine the findings or the
objectives of Leopold’s maneuver.
Not just use the fingertips, but also
use the palms. but more specifically,
you have to know how to palpate
correctly the abdomen of the mother.
It is also done externally, and
explains that the procedure is not
invasive.
➢ OBSERVATION - to know the
contour, the length of the mother’s
abdomen
PALPATION: LOCATION
➢ What you are palpating from
external abdomen is the fetal outline
➢ You can perform the Leopold’s
maneuver when the mother or the
patient is on 24 weeks onwards/ 6
months. 6 months and the fetal
outline is already visible. And better
when it is in above 24 weeks (e.g.
32 weeks) because the fetal outline
is very prominent. NOT EARLIER
THAN 24 WEEKS.
LIMITATIONS OF PROCEDURE:
➢ Not 100% diagnostic, because
Leopold’s maneuver can just
determine SOME abnormalities.
(refer to a physician if there are
some abnormalities)
MATERNAL AND CHILD
PURPOSE OF LEOPOLD MANEUVER
are to determine:
Presentation - part seen first the
fetus that is lying in the inlet or at the
cervical as Cephalic or Breech. It is
either the head or the buttocks in
contact first when the mother
delivers. The fetal body part that
comes in contact first with maternal
pelvis
➢ CEPHALIC - head/vertex
(occiput), brow (sinciput),
Face, Mentum (chin) is the
first body part that comes in
contact with maternal pelvic
➢ BREECH - when either of the
feet, buttocks, shoulder
comes out first (FOOTLING).
Attitude - degree of flexion or
extension of a part, the fetal head. It
is the relationship of the fetal body
parts with each other.
GOOD ATTITUDE
➢ The chin - should touch the
chest
➢ Chest
➢ Knees - the knees should be
flex toward the body
The baby will be delivered, the baby
will be presenting the smallest part
of the fetal head (occiput)
MILITARY ATTITUDE
➢ Baby would be in a
straight position, the
knees not flexing
towards the body.
POOR ATTITUDE
➢ The baby will be
presenting the
biggest diameter of
the head, either the
NIRO, IRISH PAULENE M.
BSN 2 - LYDIA HALL
brow, the face, or
sometimes the chin. It
is hyperextended.
Lie - relationship of the fetal long
axis and long axis of the mother.
➢ There are 2 types of fetal lie,
longitudinal line or the
transverse line.
➢ OBLIQUE LIE -
➢ LONGITUDINAL LIE - the
long axis of the baby is
parallel with the long axis of
the mother. Or it is in a
vertical position, it is either
the baby’s longitudinal lie
would be in cephalic
presentation or
footling/breech. As long as
the spine of the baby is in
vertical position with the
mother.
➢ TRANSVERSE - if the baby’s
long axis is perpendicular
with the mother
Position - relation of the point
reference.
➢ Here, it includes the fetal
presentation.
➢ ROA - right occiput anterior -
the baby’s back is facing the
right maternal side
➢ LOA - left occiput anterior -
the baby’s back is facing the
left maternal side
➢ ROA - the occiput - the fetal
presentation. If cephalic
(occiput first contact) or
breech (the feet/sacrum first
contact)
➢ ROA/ROP - the sacrum and it will
anterior/posterior. Which part
of the baby is facing.
MCN 107 - LECTURE
MATERNAL AND CHILD
➢ The first letter in fetal position
(ROA and LOA) denotes the
maternal side at which the
back of the baby is facing is
either Right or Left.
NOTE: middle of (ROA & LOA)
can be change because it is the
presentation of the baby (breech
or cephalic)
THE PRESENTATION IS IN THE
MIDDLE OF THE BABY’S
PRESENTATION
● If breech:
➢ RSA (right sacrum
anterior)
● If cephalic
➢ RMA (right
mentum (chin and
cheek) anterior)
➢ ROA/ROP -
anterior/posterior. Which part
of the baby is facing.
➢ ANTERIOR - the baby is
facing the mommy
ANTERIOR
➢ is the best position for
the baby because the
delivery will be smooth
and the head of the
baby will not be
obstructed by the
bones.
➢ The baby is also facing
the mommy
POSTERIOR
➢ the baby’s back is on
the mommy
➢ The back of the head
will be pushing those
bony prominences in
be so painful for the
mother to deliver the
baby as well as
NIRO, IRISH PAULENE M. MCN 107 - LECTURE
BSN 2 - LYDIA HALL MATERNAL AND CHILD
2. Patient should empty her bladder -
possibilities of
fractures. promotes comfort, might obscure the
assessment.
3. Examiner’s hand should be warm
4. Provide privacy
Actual number of fetuses 5. Position patient in dorsal recumbent
Term - week of the gestation of the (supine with knees flexed) or supine
baby (AOG) with wedge on the right hip (tilt left
➢ Macdonald’s rule - fundal small pillow) To prevent hypotension
height vena cava will be free
Engagement - degree that this baby ➢ Observe the woman’s abdomen for
presenting part is already settled in longest diameter and where fetal
the mother’s pelvis movement is apparent
➢ ENGAGED - If the presenting
part, either the head or the 4 MANEUVERS
buttocks is not movable/ not ➢ LM1 - Fundal Grip
floating. (pinch the ➢ LM2 - Umbilical Grip
symphysis pubis) ➢ LM3 - Pawlick’s Grip
➢ NOT ➢ LM4 - Pelvic Grip
ENGAGED/BALLOTMENT -
when pressing the symphysis
1. Getting the verbal consent
pubis and moving
2. Introduce self
upwards/float, it is not yet 3. Tell the patient what are
engaged. going to do and the
purpose/expected findings
EQUIPMENT 4. The patient should have
voided to avoid distension
Examination table
of the bladder and to
stethoscope obscure the finding
Rolled towel 5. Basin with warm water or
Tape measure warm your hands
6. Get the towel, pillow, tape
Top sheet linen
measure, and stethoscope.
Pillow
Basin and warm water (for
handwashing) POSITION : Dorsal recumbent
1. LM1 - LM3: Position
yourself in the foot part of
PALPAT WITH WARM HANDS - to avoid the mother, facing the
triggering contraction. patient.
2. Expose their abdomen
only.
PREPARATION
3. Observe
1. Explain the procedure to the
patient-verbal consent
NIRO, IRISH PAULENE M. MCN 107 - LECTURE
BSN 2 - LYDIA HALL MATERNAL AND CHILD
LM1 - FUNDAL GRIP and the fetal position (e.g.,
➢ stethoscope - to hear the fetal heart ROA - right occiput anterior,
tones LOA - left occiput anterior,
➢ Fundus is the top most portion of the etc), and lie.
mother’s womb, (what part of the
baby lies on the fundus)
➢ The superior surface of the fundus is
palpated to determine the PROCEDURE
consistency, shape, and mobility. 1. Stand facing the client
➢ “What fetal part(e.g., head or 2. Place both hands on either
buttocks) occupies the fundus (e.i., side of the abdomen
top of the uterus)?” between flanks and
Purpose: to determine fetal umbilicus.
presentation (also age of 3. The, while steadily
gestation) supporting with the right
Technique: face the mother, hand, palpate with the left
palpate with both hands hand. Palpate using deep
gentle pressure in slightly
FINDINGS: circular motion – it will helps
CEPHALIC POSITION: If to easily identify the fetal
you feel soft, irregular, moves parts
on conjunction with the body, 4. Repeat the steps on the
it indicated fetal buttoks is in other side as well using
the fundus opposite hands
BREECH: If you feel hard,
round mass which is
ballotable, it indicates that
the fundus occupies the fetal
head
LM3 - PAWLIK’S GRIP
If you feel the upper pole is
➢ Should be done in symphysis pubis
empty, indicated a transverse
➢ This maneuver confirms fetal
lie
presentation and determines its
engagement (mobility)
LM2 - LATERAL OR UMBILICAL GRIP
➢ “What is the presenting part? Is it
➢ Between the umbilicus and the flank,
engaged?”
lateral side.
➢ One hand is used to steady the
FINDINGS
uterus on one side of the abdomen
NOT YET ENGAGED-
while the other hand moves slightly
Floating baby/MOVABLE
in circular motion from top to bottom.
➢ “On which maternal side is the fetal ENGAGED - Immovable
back located?”
LM4 - PELVIC GRIP
Purpose: to determine
➢ Inguinal
where the fetal back is facing
NIRO, IRISH PAULENE M. MCN 107 - LECTURE
BSN 2 - LYDIA HALL MATERNAL AND CHILD
➢ This maneuver determines fetal
attitude and degree of fetal
extension into the pelvis
➢ Should only be done if fetus is in
cephalic presentation

FINDINGS
GOOD ATTITUDE - if brow
correspond to the side that
contained the elbow and
knees

NURSE CAUTION
➢ CONTRAINDICATION
● Leopold maneuvers should
not be performed during
uterine contraction
➢ COMPLICATIONS
● It may cause mild discomfort
to the mother especially
during the third maneuver
● And in some very rare cases,
it may trigger uterine
contractions.