Leopold's Maneuvers

Leopold's Maneuvers

http://www.fpnotebook.com/OB/Exam/LpldsMnvrs.htm

http://en.wikipedia.org/wiki/Leopold

First Maneuver (Upper pole)

• Examiner faces woman's head
  
• Palpate uterine fundus
  
• Determine what fetal part is at uterine fundus

Second Maneuver (Sides of maternal abdomen)

• Examiner faces woman's head
  
• Palpate with one hand on each side of abdomen
  
• Palpate fetus between two hands
  
• Assess which side is spine and which extremities

Third Maneuver (Lower pole)

• Examiner faces woman's feet


• Palpate just above symphysis pubis
  
• Palpate fetal presenting part between two hands
  
• Assess for Fetal Descent

Fourth Maneuver (Presenting part evaluation)

• Examiner faces woman's feet


• Move both hands gently down the sides of the uterus toward the pubis to locate the fetus' brow
  
• The side where there is the resistance to the descent of the fingers toward the pubis is greatest is where the brow is located


• If the head of the fetus is well flexed, the brow should be on the opposite side from the fetal back


• If the fetal head is extended though, the occiput is instead felt and is the brow which located on the same side as the back

Focus areas for abdominal palpation

• Assess Fundal Height: Fundal height (cm) approximates weeks of gestationAssess Fetal Lie: Longitudinal (Normal),Transverse, Oblique
• Assess Fetal Presentation: 1.Breech Presentation; 2. Cephalic Presentation:Vertex Presentation (Normal attitude: Full flexion) or Face Presentation (Abnormal attitude: Head extends)
• Assess Fetal Vertex Position: LOT 40%, LOA 12%, LOP 3%, ROL 25%, ROA 10%, ROP 10%
• Assess Fetal Descent: Is Vertex engaged?
  

Other methods of determining fetal orientation

• Obstetric Ultrasound
• Digital cervical exam