Leopold Maneuvers

By Dr. Amos Grunebaum, MD

Leopold’s Maneuvers are methods to determine position, presentation and engagement of fetus.

Leopold's maneuvers (Leopold Handgriffe) are named after Christian Gerhard Leopold,a German

Obstetrician who lived from 1846 to 1911. The Leopold maneuvers are usually done by the

doctor placing her two hands on the pregnant uterus to determine the poisition of the fetus and

it's possible size.

1. Determination of what is in the fundus

2. Evaluation of the fetal back and extremities

3. Palpation of the presenting part above the symphysis, and

4. Determination of the direction and degree of flexion of the head.

How to Perform Leopold’s Maneuver

Before performing Leopold’s Maneuver, ask the mother to empty the bladder, warm hands, and

apply them to the mother’s abdomen with firm and gently pressure.

First Leopold’s Maneuver:

1. It will determine which part of the fetus is in the fundus.

2. Place pals on each side of the upper abdomen and palpate around the fundus

3. You would feel a hard, round, movable object if the head is in the fundus

4. You would feel soft and have .\an irregular shape and are more difficult to move if the

buttock is in the fundus.

(https://www.babymed.com/pregnancy/leopold-maneuvers?fbclid=IwAR2CirnxtVR7Nh-

KWpqydXpaWb4XB1KZFFgpnWlX6Tg2K1E3Esz9lpqfkzM, n.d.)

Leopold's Maneuvers
 Leopold's maneuvers are four specific steps in palpating the uterus through the

abdomen in order to determine the lie and presentation of the fetus. In summary the

steps are:

Step 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.

Step 2. Firm pressure is applied to the sides of the abdomen to establish the location

of the spine and extremities (small parts).

Step 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.

Step 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.

(http://perinatology.com/Reference/glossary/L/Leopolds.htm, n.d.)
INTRODUCTION

In obstetrics, Leopold's maneuvers are a common and systematic way to determine the

position of a fetus inside the woman's uterus; they are named after the gynecologist Christian

Gerhard Leopold. They are also used to estimate term fetal weight. Nurses use the Leopold

Maneuvers when caring for their pregnant patients. Nurses must remember to perform 4 specific

actions as a part of these methods. The skill of the individual performing the maneuvers is

critical to determining if the fetus is in the correct position so it is very important that nurses

learn to execute the Leopold Maneuvers correctly. The Leopold Maneuvers are used to help

nurses determine fetus presentation and position. The maneuvers have 4 specific actions that

nurses must perform. Nurses use this process along with the assessment of the maternal pelvis’

shape to determine if complications will occur during the delivery and if the patient will require a

Cesarean section. Leopold’s Maneuver is preferably performed after 24 weeks gestation when

fetal outline can be already palpated.

The purpose of First Maneuver: Fundal Grip. To determine fetal part lying in the

fundus.To determine presentation. The procedure is using both hands, feel for the fetal part lying

in the fundus. Head is more firm, hard and round that moves independently of the body.

Breech is less well defined that moves only in conjunction with the body. The purpose of Second

Maneuver: Umbilical Grip. To identify location of fetal back. To determine position. The

procedure of this second maneuver is one hand is used to steady the uterus on one side of the

abdomen while the other hand moves slightly on a circular motion from top to the lower segment

of the uterus to feel for the fetal back and small fetal parts. Use gentle but deep pressure. Fetal

back is smooth, hard, and resistant surface knees and elbows of fetus feel with a number of

angular nodulation. The purpose of Third Maneuver: Pawlik’s Grip. The purpose of it to

determine engagement of presenting part. The procedure is by using thumb and finger, grasp the

lower portion of the abdomen above symphisis pubis, press in slightly and make gentle

movements from side to side. The presenting part is engaged if it is not movable.It is not yet

engaged if it is still movable. The purpose of Fourth Maneuver: Pelvic Grip. To determine the

degree of flexion of fetal head.To determine attitude or habitus. The procedure is facing foot part

of the woman, palpate fetal head pressing downward about 2 inches above the inguinal ligament.

Use both hands. Good attitude – if brow correspond to the side (2nd maneuver) that contained

the elbows and knees. Poor atitude – if examining fingers will meet an obstruction on the same

side as fetal back (hyperextended head) Also palpates infant’s anteroposterior position. If brow is

very easily palpated, fetus is at posterior position (occiput pointing towards woman’s back).

During the physical exam, using the Leopold maneuvers, palpation of a hard, round, mobile

structure at the fundus and the inability to palpate a presenting part in the lower abdomen
superior to the pubic bone or the engaged breech in the same area, should raise suspicion of a

breech presentation. During a cervical exam, findings may include the lack of a palpable

presenting part, palpation of a lower extremity, usually a foot, or for the engaged breech,

palpation of the soft tissue of the fetal buttocks may be noted. If the patient has been laboring,

caution is warranted as the soft tissue of the fetal buttocks may be interpreted as caput of the fetal

vertex. Any of these findings should raise suspicion and ultrasound should be performed.

POSITVE & NEGATIVE

Leopold's maneuvers are difficult to perform on obese women and women who

have polyhydramnios. The palpation can sometimes be uncomfortable for the woman if care is

not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care

provider should first ensure that the woman has recently emptied her bladder. If she has not, she

may need to have a straight urinary catheter inserted to empty it if she is unable

to micturate herself. The woman should lie on her back with her shoulders raised slightly on a

pillow and her knees drawn up a little. Her abdomen should be uncovered, and most women

appreciate it if the individual performing the maneuver warms their hands prior to palpation.

CONCLUSION

Leopold's maneuvers are intended to be performed by health care professionals, as they

have received the training and instruction in how to perform them. If performed at home as an

informational exercise, the examiner should take care to not roughly or excessively disturb the

fetus. It is important to note that all findings are not truly diagnostic, and as such ultrasound may

be required to conclusively determine the fetal position. There are virtually no side effects or

complications of the Leopold Methods. A skilled nurse should execute the procedure and care
should be taken not to disturb the fetus in an excessive manner. The method can be painful for

the expectant mother if the nurse performing the maneuvers is does not take care to perform the

procedure properly. Performing the 4 steps of the Leopold Maneuvers requires skill and patients

to locate the position of the mother’s fetus. The maneuvers should be performed in a manner that

is comfortable to the expectant mother.