Leopold's Maneuver

Leopold’s Maneuver by Dr. Christian Gerhard Leopold, German Gynecologist

The four classic obstetric grips and named after

leopold’s maneuver

are a systematic four-step physical examination performed to evaluate the fetal lie, presentation, and position of the fetus in the uterus.

after 26 weeks of gestation

• These obstetric maneuvers are performed; It is when the fetus is matured enough that when you palpate the abdomen its outline can be easily distinguished. 

fetal position

is described as fetal presentation in relation to mother’s pelvis. For example, right occiput anterior [ROA], left occiput anterior [LOA], left sacrum anterior [LSA], and more

fetal lie

is described as where the fetus lies in relation to the mother’s back. For example, longitudinal, transverse, and oblique lie

fetal presentation

first fetal part that presents into the maternal pelvis

fetal attitude

can be determined after head is engaged

fetal malposition

• fetus in an occiput-posterior [OP] or occiput-transverse [OT] position in labor)

• 33-58% prevalence in the 1^st Stage of labor; at delivery stage with 12-22%

pre-requisites before the procedure

• Explain the Leopold maneuvers and their purpose to the pregnant mother

• Obtain verbal consent

• Ask the client to empty her bladder

• Position patient in supine and legs partially flexed from knees

• Ensure the patient is comfortable and relaxed

• Expose the tummy (from the xiphoid process to pubic symphsis) and cover lower part of the body with a sheet to provide privacy

• Ensure your hands are warm prior to palpation

step 1: fundal height

• you palpate the uppermost part of the abdomen. this maneuver answers the question “What fetal part occupies the fundus?”

• here, you will know the fetal lie

fundal height

will give you info. about gestational age. it can be measured using a measuring tape - McDonald’s Rule

to determine the fetal lie and fundal height

purpose of the first leopold’s maneuver

transverse lie

if you feel the upper pole is empty

fetal buttocks

feel broad, firm, irregular, soft mass

fetal head

feel smooth, globular mass which is ballotable

step 2: lateral or umbilical grip

• answers “on which maternal side does the fetal back is located”

• aim: to locate the fetal back and limbs. additionally you can determine the position of the fetus

fetal’s back

best location to auscultate its heart sound

fetal back

feel continuous soft structure

fetal limbs

feel irregular multiple knoblike structure

transverse lie

head or breech may be palpated from one of the sides of maternal torso

step 3: pawlik’s grip

• answers the question “what is the presenting part?”

• was modified by Czech Gynecologist Karel Pawlik

• sometimes referred as the first pelvic grip

• to evaluate the presenting part into the pelvis and engagement

presenting part is engaged

feel the less distinct mass

step 4: pelvic grip

• answers the question “is the fetal head engaged in the pelvis and what is the attitude?”

• confirms the presenting part of the fetus and its descent into the pelvis

• you can determine the degree of engagement

floating

if fingers of both hands meet below presenting part

engaged

if fingers of both hands diverge below the presenting part

during uterine contraction

leopold’s maneuver should not be performed ________

fundal height

• pregnancy’s belly growth is measured as ___

• it helps assess baby’s growth, determine gestational age, and confirm baby due date

top of the pubic bone to the top of the uterus

fundal height distance

centimeters

fundal height is measured in __

12 weeks

fundus will be found above the symphysis pubis at __

20 weeks

fundus will be found at the belly button (umbilicus) at __

16 weeks (about 12-20 weeks)

fundus is found in the midway point between the symphysis pubis and belly button, the patient is about, ____

20=36 weeks

after about ___ the fundal height measurement should almost match the gestational age give or take 2 cm

36 weeks

the fundus should be at the xiphoid process

around 37-40 weeks (around delivery)

the fundal height actually decreases and slightly moves down about 4 cm from the xiphoid process as the baby drops into the pelvis for birth

belly button

about 1 hour after birth, the fundal height is at the ___

1cm per day; 10-14; 1 cm(or one finger breadth); 2cm below the belly button

the fundus will decrease by ____ and cant be palpated by day ____ because it has entered back into the pelvic cavity. therefore, 24 hrs after birth, the fundus should be ____ 48 hrs it should be

symphysis pubis

at 7 days pp, the fundus should be at the

pelvic cavity

at 10-14 days pp the fundus should be back in the _____ because it cant be palpated

size before pregnancy

at 6 weeks pp the uterus will be back at its ___

fetal heart rate monitoring

it the process of checking the condition of the fetus during labor and delivery by monitoring the fetus’s heart rate with special equipment after a contraction

1. auscultation

2. Electronic fetal monitoring

2 methods of fetal heart rate monitoring in labor

auscultation

• a method of periodically listening to the fetal  HR

• done with either a special stethoscope or a device called a Doppler transducer. When the transducer is pressed against the abdomen, the HCP can hear the fetus's heartbeat.

Electronic fetal monitoring

a procedure in which instruments are used to continuously record the heartbeat of the fetus and the contractions of the woman's uterus during labor.

bradycardia

when FHR falls below 120bpm, may occur spontaneously

acceleration

a transient increase in the FHR due to periods of excitement or activity

tachycardia

when FHR exceeds 160bpm and if sustained, may compromise the fetus

deceleration

a brief period of bradycardia that recovers

reactivity

type of variability; how much the heart responds to fetal rest or movement

doppler

utz converts sound waves to signals of fetal heart

fetoscope

like stethoscope, open end pressed on abdomen, used less frequently

1816, France;

stethoscope was invented in; by René Laennec

diaphragm

detects higher pitched sounds like breath and normal heart sounds

bell

detects lower pitched sounds like fetal murmurs, bowel sounds, and bruits

Cardiotocography (CTG)

s a technique used to monitor the fetal heartbeat and uterine contractions during pregnancy and labor. The machine used to perform the monitoring is called a cardiotocograph.

cardiotocograph

records the fetal heart rate and uterine contractions.