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Leopold Maneuvers

By Dr. Amos Grunebaum, MD

Leopold’s Maneuvers are methods to determine position, presentation and engagement of fetus.

Leopold's maneuvers (Leopold Handgriffe) are named after Christian Gerhard Leopold,a German

Obstetrician who lived from 1846 to 1911. The Leopold maneuvers are usually done by the

doctor placing her two hands on the pregnant uterus to determine the poisition of the fetus and

it's possible size.


They will include:

1. Determination of what is in the fundus

2. Evaluation of the fetal back and extremities

3. Palpation of the presenting part above the symphysis, and

4. Determination of the direction and degree of flexion of the head.

How to Perform Leopold’s Maneuver

Before performing Leopold’s Maneuver, ask the mother to empty the bladder, warm hands, and

apply them to the mother’s abdomen with firm and gently pressure.

First Leopold’s Maneuver:

1. It will determine which part of the fetus is in the fundus.

2. Place pals on each side of the upper abdomen and palpate around the fundus

3. You would feel a hard, round, movable object if the head is in the fundus

4. You would feel soft and have an irregular shape and are more difficult to move if the

buttock is in the fundus

(https://www.babymed.com/pregnancy/leopold-maneuvers?fbclid=IwAR2CirnxtVR7Nh-

KWpqydXpaWb4XB1KZFFgpnWlX6Tg2K1E3Esz9lpqfkzM, n.d.)
INTRODUCTION

Before performing Leopold's Maneuver, ask the mother to empty the bladder, warm

hands, and apply them to the mother's abdomen with firm and gently pressure. First Leopold's

Maneuver: It will determine which part of the fetus is in the fundus. Place pals on each side of

the upper abdomen and palpate around the fundus. The fetus undergoes a series of changes in

position, attitude, and presentation during labor. This process is essential for the accomplishment

of a vaginal delivery. The presence of a fetal malpresentation or an abnormality of the maternal

pelvis can significantly impede the likelihood of a vaginal delivery. The contractile aspect of the

uterus is another essential aspect of this process. This combination of factors has been classically

described as the passenger (the fetus), the passage (the maternal pelvis) and the powers (the

uterine contractions). This chapter addresses the impact of the fetus and the maternal pelvis on

the labor process.

BODY

Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline

can be already palpated. To assess the potential impact of the fetus on the characteristics of the
labor process, it is important that the obstetrician be knowledgeable of the basic concepts used

routinely to describe how the body of the fetus is located in the uterus. The obstetrician should be

able to determine the fetal lie, presentation, and position, using the maternal vertebral column

and pelvis as reference points, by Leopold's maneuvers, vaginal examination, and if necessary,

ultrasound. In obstetrics, Leopold's maneuvers are a common and systematic way to determine

the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian

Gerhard Leopold. They are also used to estimate term fetal weight. The maneuvers consist of

four distinct actions, each helping to determine the position of the fetus. The maneuvers are

important because they help determine the position and lie of the fetus, which in conjunction

with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is

going to be complicated, or whether a Cesarean section is necessary. The examiner's skill and

practice in performing the maneuvers are the primary factor in whether the fetal lie is correctly

ascertained. Alternately, position can be determined by ultrasound performed by a sonographer

or physician.

POSITIVE AND NEGATIVE

Positive of Leopold maneuvers include the fact that the procedure is relatively easy to

perform and does not incur the expense of ultrasound. Negative of Leopold maneuvers include

low sensitivity for macrosomia. In general, estimates of fetal weight are more likely to

underestimate the weight of macrosomic infants than to overestimate the weight.

CONCLUSION

Abdominal palpation remains a common method to estimate the uterine size. Leopold’s

maneuvers are still common in daily obstetrics practice. The first and third Leopold’s maneuver
are the most frequent abdominal grips. Ultrasound is commonly used by obstetricians to

determine fetal orientation. Leopold's maneuvers are intended to be performed by health care

professionals, as they have received the training and instruction in how to perform them. If

performed at home as an informational exercise, the examiner should take care to not roughly or

excessively disturb the fetus. It is important to note that all findings are not truly diagnostic, and

as such ultrasound may be required to conclusively determine the fetal position.

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