Nursing Procedure for Skills Lab

NCM 107
Leopold's Maneuver

Definition

Leopold’s Maneuver is a common and systematic way to determine the position of a fetus inside the
woman's uterus. It is named after the gynecologist Christian Gerhard Leopold.

Purposes

1. Systematically observing and palpating the abdomen to:

❖ Determine of what is in the fundus

❖ Evaluate the fetal back

❖ Palpate the presenting part and extremities

❖ Determine the direction and degree of flexion of the head

2. The data provide general and specific information that can be used to plan care during the antepartum and
intrapartum period

Implementation
STEPS RATIONALE

A. Prepare the client

1. Explain the procedure Explanation reduces anxiety and enhances cooperation

2. Instruct the patient to empty her bladder Doing so promotes comfort and allows for more
productive palpation because a distended bladder
will not obscure fetal contour

3. Position the woman I supine with knees slightly flexed Flexing the knees relaxes the abdominal muscle

4. Wash hands using warm water Washing hands prevents the spread of possible
infection. Using warm water aids in client’s comfort
and preventing tightening of abdominal muscles

5. Observe the women’s abdomen for longest The longest diameter (axis) is the length of the fetus.
diameter where fetal movement is apparent The location of activity most likely reflects the
position of the feet

A. Perform the first maneuver (Fundal Grip) This maneuver determines whether fetal hand or
breech is in the fundus
 Proper positioning of hands ensures accurate
1. Stand at the foot of the patient, facing her
and placing both hands flat on her abdomen
findings When palpating a head feels more firm
2. Palpate the superior surface of the fundus.

than breech. A

Determine consistency, shape and mobility head moves independently of the body, the
breech moves only in conjunction with the body.

B. Perform the second maneuver (Umbilical Grip) This maneuver locates the back of the fetus

1. Face the patient and place the palms of Proper positioning of hands ensures accurate findings
each hand on either sides of the abdomen

2. Palpate the sides of the uterus. Hold the left This method is most successful to determine the
hand stationary on the left side of the uterus direction of the fetal back. One hand will feel a
while the right hand palpates the opposite smooth hard resistance surface (the back), while the
side of the uterus from top o bottom. Then opposite side, a number of angular modulation (the
hold the right steady, and repeat palpation knees and elbows of the fetus) will be left.
using the left hand on the left side

C. Perform the third maneuver ( Pelvic grip or This maneuver determines the part of the fetus at
Pawlik's grip) the inlet and its mobility

1. Gently grasp the lower portion of the If the presenting parts moves upward, so that
abdomen just above the symphysis pubis examiner’s hands can be pressed together the
between the thumb and index finger and try to presenting part is not engaged (not firmly settled into
press the the pelvis). If the part is firm it is the head; if soft then
thumb and the finger together. Determine it is breech.
any movement whether the part is firm or
soft

D. Perform the fourth maneuver (Pelvic Grip) This maneuver determines fetal attitude and degree
of fetal extension into the pelvis; this should be done
only if fetus is in cephalic presentation. Information
about the infant’s Anteroposterior position may also
be gained from this final maneuver

1. Place fingers on both side of the uterus The fingers of one hand will slide along the uterine
approximately 2 inches above the inguinal contour and meet no obstruction, indicating the back
ligaments, pressing downward and inward in of the fetal neck. The other hand will not meet an
the direction of the birth canal. Allow fingers obstruction an inch or so above the ligament-this is
to be carried downward. the fetal brow. The position of the fetal brow should
correspond to the side of the uterus that contained
the elbows and knees of the fetus. If the fetus is in
poor attitude, the examining fingers will meet an
 obstruction of the same side of the fetal back. That is
the finger will touch the hyper-extended head. If the
brow is very easily palpated (as if it lies under the
skin), the fetus is probably in a posterior position (the
occiput is pointing toward a woman’s back

Nursing Consideration

1. As a rule the examiner can accurately assess fetal position after the24th- 28 th weeks because the uterine
and abdominal muscles are stretched and thinned
2. The examiner may have trouble assessing fetal position if the patient has hydramnous; very obese and
carrying more than one fetus. The fetus is unusually small. The tumor or other unusual growth is present in
the uterus or the placentas placement obstructs palpation.
3. Ask the patient empty her bladder so the examiner wont confuse it with the fetal head
4. With warm hand and gentle pressure, palpate the abdomen for soft consistency, fluctuating amniotic fluid,
indefinite outlines and baby’s small knobby/crooked part

dReference: Maternal and Child Health Nursing, Care of Childbearing and Childrearing Family Adele Pillitteri
5th ed. 2007.

Leopold’s Maneuver is preferably performed after 24 weeks gestation when the fetal outline can be already palpated.

Preparation:
1. Instruct the woman to empty her bladder first.
2. Place the woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a
small pillow under the head for comfort.
3. Drape properly to maintain privacy.
4. Explain procedure to the patient.
5. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions).
6. Use the palm for palpation not the fingers.
Steps Purpose Procedure Findings

First Maneuver: To determine fetal Using both Head is more firm, hard and round
Fundal Grip part lying in the hands, feel for that moves independently of the
fundus. To the fetal body. Breech is less well defined that
determine part lying in the moves only in conjunction with the
presentation. fundus. body.
Second To identify One hand is used Fetal back is smooth, hard, and
Maneuver: location of fetal to steady the resistant surface Knees and elbows of
Umbilical Grip back. To uterus on one fetus feel with a number of angular
determine position. side of the nodulation
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.

Third To determine Using thumb and The presenting part is not engaged if it
Maneuver: engagement of finger, grasp the is not movable. It is not yet engaged if
Pawlik’s Grip presenting part. lower portion of it is still movable.
the abdomen
above symphysis
pubis, press in
slightly and make
gentle
movements
from side to
side.

Fourth To determine the Facing foot part of Good attitude – if brow corresponds to

Maneuver: degree of flexion the woman, the side (2nd maneuver) that
Pelvic Grip of fetal head. To palpate fetal contained the elbows and knees.
determine head pressing Poor attitude – if examining fingers
attitude or downward about will meet an
habitus. 2 inches above obstruction on the same side as
the fetal back (hyper-extended head)
inguinal ligament. Also
Use both hands. palpates infant’s anteroposterior
position. If brow is very easily
palpated, fetus is at posterior
position (occiput pointing towards
woman’s back

Reference:

https://www.rnpedia.com/nursing-notes/maternal-and-child-nursing-notes/performing-leopolds-maneuver/