LEOPOLD'S MANEUVER

LEOPOLD’S MANEUVER

Systematic palpation of the pregnant woman's abdomen to determine: Presentation, fetal lie, position, attitude, engagement of the fetus.

28 weeks

Done at ____ weeks AOG and over; must be done in a consistent and systematic fashion to yield reliable results.

• Fetal lie

• Fetal Presentation 

• Fetal Attitude 

• Fetal Position

• Engagement of the fetus

Leopold’s maneuver determines the: (5)

• longitudinal

• oblique

• transverse

Fetal lie can be (3)

• cephalic

• breech

• shoulder

fetal presentations (3)

• vertex/occiput

• sinciput/military

• brow

• face

Kinds of cephalic presentations (4)

Footling

_____– foot is presented first, hard to deliver because head may get stuck; certain maneuvers must be done

9.5 cm

vertex presentation size

12 cm

Sinciput presentation size

13.5 cm

Brow presentation size

• Complete breech 

• Incomplete breech

• Frank breech

Variations of breech presentation

FETAL ATTITUDE

• Relation of different parts of the fetus to one another

  • Flexion 

  • Extension

4th

Fetal attitude is discerned when ___ maneuver is done

vertex

most favorable fetal position is __

• Occiput (O)

• Side of the pelvis (A) – Anterior; Front

• Symphysis pubis or (P) 

  Posterior; Back

• Sacrum

  
  

Presenting Part: vertex

Fetal point of reference: ?

Maternal Pelvic relationship: ?

• Mentum (M)

• Right & Left side (R or L)

Presenting Part: face/chin

Fetal point of reference: ?

Maternal Pelvic relationship: ?

• sacrum

• transverse

Presenting Part: Breech

Fetal point of reference: ?

Maternal Pelvic relationship: ?

• Acromion (A)

Presenting Part: shoulder

Fetal point of reference: ?

Maternal Pelvic relationship: ?

• • ROP 

  • ROT

  • ROA (most common) 

  • LOP 

  • LOA (most common) - mas common sa ROA

• Most favorable positions: 

ischial spine

Marker for fetal station

1. Instruct the woman to empty her bladder first.

2. Place the woman in a 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. Warm hands by rubbing them together

   Use the palm for palpation, not the fingers

Preparation for Leopold’s Maneuver

FIRST MANEUVER: FUNDAL GRIP

• Determine fetal presentation and aid in location of fetal heart sounds

• To determine fetal part lying in the fundus

FUNDAL GRIP

SECOND MANEUVER: UMBILICAL GRIP

• To identify location of fetal back

SECOND MANEUVER: UMBILICAL GRIP

THIRD MANEUVER: PAWLIK'S GRIP

To determine engagement of presenting part

FOURTH MANEUVER: PELVIC GRIP

• To determine the degree of flexion of the head

• To determine attitude or habitus

Good

_____ attitude – if the brow corresponds to the side (2nd maneuver) that contains the elbows and knees.

Poor

___ attitude – If examining fingers, will meet an obstruction

TRUE

Inspect the abdomen for the following: 

• Scars, Diastasis recti, Hernia, Linea nigra. Striae gravidarum, Contour of the abdomen

• State of the umbilicus, skin condition

ulnar

Determine the fundal height using the ____ side of the palm

12 weeks

•  level of symphysis

16 weeks

midway between symphysis pubis and umbilicus

20 weeks

 level of umbilicus

32 weeks

at level of xiphoid process

36 weeks

at level of xiphoid process

40 weeks

2 to 3 finger breadths below the xiphoid process if lightening occurs

Longitudinal (vaginal lie)

_______ lie — Most favorable for vaginal birth

Cephalic

_____ — more favorable than breech for vaginal birth

vertex

• The chin is touching the chest; fully flexed head

• Most favorable for vaginal birth because head is fully flexed

sinciput

• Military attitude (12cm)

• Slightly flexed

• Sutures overlap so the head of the fetus can pass through

brow

Slightly extended head

face

Completely extended

forceps and vacuum

Brow - 13.5 cm - vaginal delivery is possible but with instruments like ___ and __

LOA

More common (LOA/ROA)?