Leopold's Maneuvers

Leopold's Maneuvers

First Maneuver (Upper pole)Examiner faces woman's headPalpate uterine fundusDetermine what fetal part is at uterine fundusSecond Maneuver (Sides of maternal Abdomen)Examiner faces woman's headPalpate with one hand on each side of AbdomenPalpate fetus between two handsAssess which side is spine and which extremitiesThird Maneuver (Lower pole)Examiner faces woman's feetPalpate just above symphysis pubisPalpate fetal presenting part between two handsAssess for Fetal DescentFourth Maneuver (Presenting part evaluation)Examiner faces woman's headApply downward pressure on uterine fundusHold presenting part between index finger and thumbAssess for cephalic versus Breech Presentation

ExamFocus areas for abdominal palpation

Assess Fundal HeightFundal height (cm) approximates weeks of gestationAssess Fetal LieLongitudinal (Normal)TransverseObliqueAssess Fetal PresentationBreech PresentationCephalic PresentationVertex Presentation (Normal attitude: Full flexion)Face Presentation (Abnormal attitude: Head extends)Assess Fetal Vertex PositionPalpate the sagittal Suture (may be obscured by caput)Anterior Fontanelle has 4 adjacent Suture linesPosterior Fontanelle has 3 adjacent Suture linesPalpate ear positionPositionsLeft Occiput Lateral (LOL) 40%Left Occiput Anterior (LOA) 12%Left Occiput Posterior (LOP) 3%Right Occiput Lateral (ROL) 25%Right Occiput Anterior (ROA) 10%Right Occiput Posterior (ROP) 10%Assess Fetal DescentIs Vertex engaged?

Other methods of determining Fetal Orientation

Obstetric Ultrasound
Digital cervical exam