LEOPOLD’S MANEUVERS

Mary Grace Morada-Cu, MAN, RN

Nursing Care Management 107
SPUM- CNAHS

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LEOPOLD’S MANEUVERS
• Palpation of the pregnant
mother's abdomen to
determine the fetal
position, presentation,
engagement, attitude, and
locate the fetal parts.

https://medical-dictionary.thefreedictionary.com/Leopold%27s+maneuvers

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 LEOPOLD’S MANEUVERS
• assist in determining the fetal lie, presentation, size
and position of the fetus
a. Fetal lie – where the fetus is lying in relation to
the mother’s back
 LEOPOLD’S MANEUVERS
b. Presentation – the presenting part of the fetus into the maternal pelvis
Cephalic Breech Transverse
 LEOPOLD’S MANEUVERS
c. Position – the fetal presentation in relation to the
maternal pelvis
 LEOPOLD’S MANEUVERS
c. Fetal Attitude – describes the degree of flexion a
fetus assumes during labor or the relation of the fetal
parts to each other
• involve palpating the fundus, lateral aspects of
the abdomen and the lower pelvic area

fundus –

symphysis pubis -
Objectives
• To determine presentation and position of the fetus
and aid in location of fetal heart sounds.

https://medical-dictionary.thefreedictionary.com/Leopold%27s+maneuvers

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Materials/ Equipment
• Pillow
• Topsheet
• Pair of gloves
• Stethoscope

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Procedure Steps –
PREPARATORY PHASE
1.Assemble all necessary equipment.
2. Introduce self and verify client’s identity
3. Close room doors and windows, draw
room divider

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Procedure Steps - Assessment
• 4. Assess if the client is past her 24th week
of gestation when fetal outline can be
already palpated

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Procedure Steps - Planning
• 5. At the end of the procedure
• The fetal presentation and position is
determined
• The fetal heart sounds is located

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 Procedure Steps - Implementation
• 6. Explain the maneuvers to the client and the rationale for each step as it
performed. Tell her what is found at each step.
Rationale: Explanation allays anxiety and embraces cooperation. Giving
information, teaches the client and reassures her when assessment findings
are normal
• 7. Ask the client to empty her bladder if she has not done so recently. Have
her lie on her back with her knees flexed slightly. Place a small pillow or folded
towel under one hip
Rationale: Decreases discomfort of a full bladder during palpation and improves
ability to feel fetal parts in the suprapubic area. Knee flexion helps the client
relax her abdominal muscles to enhance palpation. Uterine displacement
prevents aorta-caval compression, which could reduce blood flow to the
placenta
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 Procedure Steps - Implementation
• 8. Wash your hands with warm water. Wear gloves if
contact with secretions is likely.
Rationale: prevents transmission of microorganisms. Warm
hands are more comfortable for client.

• 9. Stand beside the client, facing her head, with your

dominant hand nearest her.
Rationale: The first three maneuvers are most easily
performed in this position.
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 Procedure Steps – 1st Maneuver
• 10. Palpates the funds with both hands to identify
the part of the fetus that lies on the upper part of
the uterus. The head feels round and hard and can
be moved from side to side on the neck. A fetal
head on the fundus indicates a breech
presentation. The buttocks feel soft, triangular,
and not movable. If buttocks are felt on the
fundus, it indicates a cephalic presentation.
Rationale: Distinguishes between a cephalic and
breech presentation. If fetus is in a cephalic
presentation, the breech is felt in the fundus. If the
presentation is breech, the head is felt in the
fundus..
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 Procedure Steps - 2nd Maneuver
• 11. Place hands at the sides of the
abdomen. Palpate in a downward
direction on the two sides of the
uterus. Hold the left hand steady on
one side of the uterus while palpating
the opposite side of the uterus with
the right hand.
Rationale: Determines on which side of
the uterus is the back and on which
side are the fetal arms and legs “small
parts”.

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 Procedure Steps -3rd Maneuver
• 12. Palpate the suprapubic area. If a breech was
palpated in the fundus, expect a hard, rounded
head in this area. Attempt to grasp he presenting
part gently between the thumb and fingers. If the
presenting part is not engaged, the gasping
movement of the fingers moves it upward in the
uterus.
Rationale: Confirms the presentation determined in
the 1st maneuver. Determines whether the
presenting part is engaged (widest diameter at or
below zero station) 
• Omit the 4th maneuver if the fetus is in Breech
presentation
Rationale: Is performed only in cephalic presentations
to determine whether the fetal head is flexed.

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 Procedure Steps -4th Maneuver
• 13. Turn so that you face the client’s feet
Rationale: Is most easily performed in this
position
• 14. Place your hands on each side of the
uterus with fingers pointed toward the pelvic
inlet. Slide hands downward on each side of
the uterus.
Rationale: Determines whether the head is flexed
(vertex) or extended (face). The vertex
presentation is normal. If the head is flesed,
the cephalic prominence (the forehead in this
case) is felt on the opposite side from the fetal
back. If the head is extended, the cephalic
prominence (occiput in this case) is felt on the
same side as the fetal back.
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Procedure Steps – PostImplementation
• 15. Validate data gathered for accuracy,
reliability and completeness
• 16. Discard PPE appropriately and perform
hand washing

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Procedure Steps - Evaluation
17.Interpret result
18.Evaluate using the following criteria:
19.Fetal position and presentation is determined
20.Fetal heart sounds is located
21.Report significant findings that needs immediate
attention to the clinical instructor or nurse
supervisor or physician
22.Documents and record findings in the chart using
appropriate terminologies
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FUNDIC HEIGHT
MEASUREMENT
Mary Grace Morada-Cu, MAN, RN
Nursing Care Management 107
SPUM- CNAHS

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FUNDIC HEIGHT MEASUREMENT
• Measuring the height of
the pregnant client’s
uterus from the superior
aspect of the pubis to the
fundal crest to determine
fetal growth and
development during
pregnancy.

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Objectives
• To assess the growth
and development of a
fetal well being

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Materials/ Equipment
• Pillow
• Topsheet
• Pair of gloves
• Tape Measure

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Procedure Steps –
PREPARATORY PHASE
1.Assemble all necessary equipment.
2. Introduce self and verify client’s identity
3. Close room doors and windows, draw
room divider

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Procedure Steps - Assessment
• 4. Assess the pregnant woman’s age of
gestation (AOG)

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Procedure Steps - Planning
• 5. At the end of the procedure Client’s age
of gestation will be validated

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Procedure Steps - Implementation
6. Explain to the client the procedure and its
importance. Explain how she can cooperate.
7. Ask the client to empty her bladder if she has not
done so recently. Place client in a dorsal recumbent
position with knees flexed and separated
8. Wash your hands with warm water. Wear gloves if
contact with secretions is likely.
9. Drape the patient appropriately

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 Procedure Steps - Implementation
9. Stand beside the client,
facing her head, with your
dominant hand nearest
her.
10.Find the top of the uterus-
fundal crest (it feels like a
hard ball under the skin)
11.Find the top of the pubic
bone by palpating
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 Procedure Steps - Implementation
13. Place the tape flat against
the abdomen for
measurement, with
centimeter measurement
facing up
14. Measure fundic height from
the superior aspect of the
pubis to the fundal crest.
15. Position the patient back to
position of comfort

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Procedure Steps – PostImplementation
• 16. Validate data gathered for accuracy,
reliability and completeness
• 17. Discard PPE appropriately and perform
hand washing

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Procedure Steps - Evaluation
18. Interpret result
19. Evaluate using the following criteria:
20. Client’s computed LMP AOG is the same as the fundic
height measurement AOG (roughly equal or +/-2cm)
21. Report significant findings that needs immediate
attention to the clinical instructor or nurse supervisor
or physician
22. Documents and record findings in the chart using
appropriate terminologies

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FUNDIC HEIGHT
MEASUREMENT
Mary Grace Morada-Cu, MAN, RN
Nursing Care Management 107
SPUM- CNAHS

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