LEOPOLDS MANEUVER (ABDOMINAL EXAMINATION)

Leopolds Maneuvers
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are a systematic method of observation and palpation to determinefetal position, presentation, lie
and attitude. It is preferably performed after 24 weeks gestationwhen fetal outline can be palpated

Keen observation of abdomen should give data about:

1.longest diameter in appearance (longest diameter (axis) is the length of the fetus)
2.location of apparent fetal movement (the location of the activity most likely reflects theposition of the
feet)
I. PREPARATION
(1)CARDINAL RULE
(1) Instruct woman to empty bladder first
Rationale: This will promotes comfort and allows for more productive palpation because fetal
contour will not be obscured by a distended bladder
(2) Place woman in dorsal recumbent position, supine with knee flexed
Rationle: to relax abdominal muscles. Place a small pillow under the head for comfort
(3)Drape properly to maintain privacy
(4)Explain procedures to gain patients cooperation
(5)Warm hands
o

first by rubbing them together before placing them over the womansabdomen to aid comfort.
Rationale: Cold hands may stimulate uterine contractions

(6)Use the palm for palpation not fingers

(7)During the first three maneuvers, stand facing the patients
For the last maneuver, stand facing patients feet
II. THE FOUR MANEUVERS
FIRST MANEUVER / Fundal Grip/ LM1
: What fetal pole or part occupies the fundus?-palpation of the fundal area to determine which fetal part is
located in the uterine fundus-to determine the:
presenting part or presentation (part of the fetus lying over the inlet)
age of gestation via fundic height
Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN

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PROCEDURES
(1)Midwife stands at the side of the bed, facing the client
(2)Using both hands, feel for the fetal par lying in the fundus
FINDINGS
-The midwife-midwife should ascertain what is lying at the fundus by feeling theupper abdomen (fundus)
with tips of both hands. Generally, she will find there isa mass, which will either be the head or
the buttocks (breech) of he fetus. Themidwife-midwife must decide which pole of the fetus; it is by
observing
Three points
1.Relative consistency - the head is harder/ firmer than the breech
2.Shape - if the head, it will be round and hard, and the transverse groove of the neck maybe felt. The
breech has no groove and usually feels more angular
3.Mobility - the head will move independently of the trunk; but the breech moves only inconjunction with
the body-If the midwife-midwife feels the head, the fetus is in breech presentation; if the midwifemidwifefeels the buttocks, it means the fetus is in vertex presentation
SECOND MANEUVER/ Umbilical Grip/LM2
: Which side is the fetal back?-to locate/identify the
fetal back in relation to the right and left sides of the mother
fetal position (the relationship of the presenting part to one of the quadrantsof the mothers pelvis
PROCEDURES
(1)The midwife-midwife places the palmar surfaces of both hands on either side of the abdomen.
(2) With left palm stationary on the left side of the abdomen to steady theuterus the right palpates the right
side of the uterus on a circular motionfrom top to lower segment of the uterus applying gentle but deep
pressureto palpate the fetal outline and small fetal parts
(3)The midwife-midwife then reverses her hands.
FINDINGS
-Small fetal parts (knees and elbows) feel nodular with numerous angular nodulations-Fetal back feels
smooth, hard, like a resistant surface
THIRD MANEUVER/ Pawliks Grip/LM3
: What fetal part lies above the pelvic inlet?-determine if the

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 presenting part has entered the pelvis

(engagement of presenting part)-to find the head at the pelvis and to determine the
Ballottement - mobility of the presenting part
PROCEDURES
(1) midwife stands at the side of the bed, facing the client
(2)It should be conducted by gently grasping the lower portion of the abdomen, just above the symphisis
pubis, between the thumb and the two fingers of one hand and then pressing together slightly and make
gentle movements from side to side
FINDINGS
-If the presenting part moves, round, balottable and easily displaced it is not yet engaged. If the presenting
part is not movable felts as relatively fixed,knoblike part, it is engaged.-If it is firm, it must be the head. If
soft, it could be breech
FOURTH MANEUVER/ Pelvic Grip/LM4
: Which side is the cephalic prominence?
Cephalic prominence
-is part of the fetal head that prevents the deep descent with one hand-to determines the degree of fetal
head flexion or extension-to determine the
attitude or habitus
(degree of flexion of the fetal body, head and extremities,or the relationship of fetal parts to each other)to determine the
fetal descent
-should only be done if fetus is in cephalic presentation. Information about the infants anteioposterior
position may also be gained from this final maneuver
PROCEDURES
(1)The midwife-midwife faces the feet of the client(2)Place one hand each on either side of the lower pole
of the uterus(3)Palpate the fetal head by pressing downward about 2 inches above theinguinal
ligament(4)Use both hands
FINDING
-If descended deeply, only a small portion of the fetal head will be palpated.-If cephalic prominence or
brow or the baby is on the same side of the smallfetal parts, the head is flexed-If the cephalic prominence
is on the same side of the fetal back, the head is extended

Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN

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Copyright: JONAS MARVIN MERCURIO ANAQUE, RM, RN

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