[RLE] CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS)
LEOPOLD’S MANEUVER
LEOPOLD’S MANEUVERS 1ST MANEUVER: FUNDAL GRIP
Christian Leopold, german physician PROCEDURE
ABDOMINAL INSPECTION & PALPATION
Stand at the foot of the woman, facing her, and place
both hands flat on her abdomen
Are systematic method of observation and palpation
Palpate the superior surface of the fundus
to determine fetal presentation and position
Determine consistency, shape, and mobility
Done as part of a physical examination
One of the four methods in determining fetal position, PRINCIPLE
presentation and lie
Determines whether the fetal head or breech is in the
PURPOSES fundus
Head: firm, round and head, moves independently
To provide information about fetal presentation,
position, presenting part i.e. Lie, attitude, and Breech/buttocks: softer, moves in conjunction with
descent the body
To aid in location of fetal heart rates 2ND MANEUVER: UMBILICAL GRIP
To aid in assessment of fetal size
Determination of single versus multiple gestation PROCEDURE
FOUR MANEUVERS Face the woman, hold the left hand stationary on the
left side of the uterus while you palpate with the right
hand and the opposite side of the uterus from top to
bottom
Repeat palpation using the opposite side
PRINCIPLE
Locates the fetal back – smooth, hard, and resistant
surface;
The knees and elbows of the fetus on the opposite
side feel more like a number of angular bumps or
nodules
3RD MANEUVER: PAWLICK’S GRIP
PROCEDURE
Using thumb and finger, grasp the lower portion of
the abdomen above symphysis pubis, press in
Maneuver is preferably performed after 24 weeks
slightly and make gentle movements from side to
gestation when fetal outline can be already palpated.
side.
The maneuver are not truly diagnostic.
Actual position can be determined by ultrasound PRINCIPLE
performed by a competent technician or professional
determines which part of the fetus is at the inlet and
FACTORS AFFECTING THE PERFORMANCE OF THE its mobility
MANEUVER head: firm, round and head, moves independently
breech/buttocks: softer, moves in conjunction with
Difficult to perform in obese women
the body
Women with hydramnios
* if the presenting part moves upward so your fingers
Women with full bladder and thumb can be pressed together, the presenting
PROCEDURE part is not engaged (not firmly settled into the pelvis)
PREPARATION 4TH MANEUVER: PELVIC GRIP
Instruct woman to empty her bladder first. PROCEDURE
Place woman in dorsal recumbent position, supine
Facing foot part of the woman, palpate fetal head
with knees flexed to relax abdominal muscles.
pressing downward about 2 inches above the
Place a small pillow under the head for comfort.
inguinal ligament. Use both hands.
Drape properly to maintain privacy.
This maneuver is only done if the fetus is in cephalic
Explain procedure to the patient.
presentation
Warms hands by rubbing together. (cold hands can
stimulate uterine contractions).
Use the palm for palpation not the fingers.
[RLE] CARE OF MOTHER, CHILD, AND ADOLESCENT (WELL CLIENTS)
LEOPOLD’S MANEUVER
PRINCIPLE
Determines whether the fetal attitude and degree of
fetal extension
Good attitude – if brow correspond to the side (2nd
maneuver) that contained the elbows and knees.
Poor attitude – if examining fingers will meet an
obstruction on the same side as fetal back
(hyperextended head) also palpates infant’s
anteroposterior position. If brow is very easily
palpated, fetus is at posterior position (occiput
pointing towards woman’s back
