Leopold's Maneuver

Leopold's Maneuver

are a systematic method of observation and palpation to estimate fetal size, locate parts, and determine presentation, position, lie, engagement and attitude

1. estimate fetal size

2. locate parts

3. determine (PPLEA)

   1. presentation

   2. position

   3. lie

   4. engagement

   5. attitude

what will you observe and palpate during leopold maneuver

gravidity

means pregnancy

gravida

woman who is pregnant

primigravida

woman who is pregnant for the first time

multigravida

woman who has had 2 or more pregnancies

nulligravida

woman who has never been pregnant

parity

refers to number of pregnancies in which the fetus or fetuses have reached 20 wks of gestation when they are born, not the number of fetuses, whether it is born alive or is stillborn

primipara

woman who have complete one pregnancy who have reached 20 wks of gestation

multipara

woman who have completed 2 or more pregnancies to gestation of 20 wks or more

nullipara

woman who has not completed a pregnancy with a fetus or fetuses who have reached 20 wks of gestation

fetal attitude

describes the relationship of fetal parts to one another

fetal attitude

used to designate the characteristic posture assumed by the fetus inside the utero

habitus

other term for fetal attitude

1. consistency of abdominal wall and uterine wall

2. amount of amniotic fluid

3. movements of extremities of mother

fetal attitude is often modified by

presentation

means the portion of fetus which engages at pelvic inlet and is felt through the cervix on vaginal examination

1. cephalic presentation

2. breech

3. shoulder

3 types of presentation

1. occiput or vertex presentation

2. face

3. sinsiput

4. brow

4 types of cephalic presentation

1. full or complete breech

2. frank

3. footling / incomplete

3 types of breech presentation

sinciput presentation

military attitude with anterior fontanelle presenting

brow presentation

cephalic presentation

partial extension

face presentation

cephalic presentation

poor flexion, complete extension

vertex presentation

cephalic presentation

full flexion

sinciput

cephalic presentation

moderate flexion, military attitude

vertex

cephalic presentation

sinciput

cephalic presentation

brow

cephalic presentation

face

cephalic presentation

chin anterior

cephalic presentation

chin posterior

cephalic presentation

complete breech

breech presentation

incomplete breech

breech presentation

frank breech

breech presentation

transverse lie presentation / shoulder

type of presentation

head first facing backwards

normal delivery presentation

1. breech

2. face

3. shoulder

abnormal deliveries

fetal lie

means the relationship which the long axis of the fetus to the long axis of the mother

longitudinal lie

normal fetal lie

1. longitudinal

2. transverse

3. oblique

3 types of fetal lie

longitudinal lie

one wherein the long axis of the fetus is parallel to the long axis of the mother

1. cephalic

2. breech

2 types of presentation for longitudinal lie

transverse lie

when the fetal axis crosses the maternal axis such that they are perpendicular to one another

shoulder presentation

type of presnetation for transverse lie

oblique lie

when the fetal axis crosses the maternal axis at an angle but not at right angles

oblique lie

this type of lie is only temporary and maybe converted into a longitudinal or transverse lie under the influence of uterine contractions

position

defined as the relationship of an arbitrarily chosen portion of fetus to the left or right of the mother’s pelvis anterior or posterior

1. cephalic

2. breech

3. face

4. shoulder

4 types of position

small fontanelle or occiput

position of cephalic

tip of the sacrum

position of breech

chin or mentum

position of face

acromion process of the scapula

position of shoulder

LOP (left occiput posterior)

position

LOT (left occiput transverse)

position

LOA (left occiput anterior)

position

ROP (right occiput posterior)

position

ROT (right occiput transverse)

position

ROA (Right occiput anterior)

position

left occiput anterior

position

right occiput anterior

position

station

dorsal recumbent

position of client during leopold maneuver

1. fundal grip

2. lateral grip

3. pawlik’s grip

4. pelvic grip

4 types of maneuvers

fundal grip

examiner stands at side of bed facing women’s head and palpate uterine fundus

uterine fundus

what will you palpate during fundal grip

fetal part

in fundal grip, what will you determine at the uterine fundus

1. relative consistency

2. shape

3. mobility

in fundal grip, what will you observe at the uterine fundus

fundal grip

this type of maneuver determines the presentation

first maneuver

determine what occupies at the fundus

1st maneuver - fundal grip

type of maneuver

lateral grip

examiner face woman’s head and palpate with one hand on each side of abdomen

lateral grip

assess which side is the fetal back and which extremities

fetal back

lateral grip

• smooth curve, hard, resistant part

knees and elbows

lateral grip

• number of angular nodulations

• small parts of the fetus

2nd maneuver

type of maneuver

lateral grip

determine location of fetal heart tones

bell

after identifying back of fetus, the ____ of stethoscope is placed to determine FHT

120 to 160 bpm

normal FHT

pawlik’s grip

examiner stands at side and facing the client and grasp lower portion of abdomen, just above the symphysis pubis using thumb and 2 fingers of one hand and pressing together

pawlik’s grip

assess for presenting part and if it is engaged or still floating

pawlik’s grip or 3rd maneuver

determine position and mobility of presenting part

pawlik’s grip or 3rd maneuver

type of maneuver

pelvic grip

examiner face woman’s feet and determines fetal attitude and fetal position

pelvic grip

examiner place tips of 3 fingers on either side of symphysis pubis, just above inguinal ligament and press fingers downward and inward

brow

in pelvic grip, if one hand will meet an obstruction above ligament what is it

nape

in pelvic grip, if one hand have none what is it

pelvic grip or 4th maneuver

type of maneuver

good attitude and full flexion

in pelvic grip,

• when the brow is on the same side as small parts

• chin is touching the chest and vertex presenting

poor flexion

in pelvic grip,

• when brow is on same side with the back

• fetal head is hyperextended