Leopolds

Maneuver

Learning Objective
Understand Leopolds Maneuver , Purpose and Outcome

Leopolds Maneuver
Are used to determine the orientation of the fetus through abdominal palpation

Overview and Rationale

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 presentation of the fetus, which in conjunction with correct assessment of the maternal pelvis can indicate whether or not the delivery is going to be complicated, or whether on not a cesarean section is necessary.

 The examiners skills and practice in performing the maneuvers are the primary factor in whether or not the fetal lie is correctly ascertained, and so the maneuvers are not truly diagnostic. Actual position can only be determined by ultrasound performed by a competent technician or professional.

Difficulties in Performing Maneuvers

When client is obese When client has hydramnios The palpation can be uncomfortable if woman is not relaxed and adequately position.

Aid in Performing the Maneuvers

The health care provider should ensure that the woman has recently emptied the bladder If not she may need to have a straight urinary catheter inserted to empty it if she is unable to micturate herself. The woman should lay on her back with her shoulders raised slightly on a pillow and her knees drawn up a little The abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation.

Abdominal Palpation
The mother should be supine and comfortably positioned with her abdomen bared. During the first three maneuvers, the examiner stands at the side of the bed that is most convenient and faces the patient The examiner reverses this position and faces her feet for the last maneuver.

Reminder
Patient should empty her bladder Examiners hand should be warm Explain the procedure to the patient Provide clients privacy Position patient in dorsal recumbent

Four maneuver's employed to determine fetal position:

determination of what is in the fundus; evaluation of the fetal back and extremities; palpation of the presenting part above the symphysis; determination of the direction and degree of flexion of the head.

Procedure
Prepared by: CYNTHIA DELA CRUZ

First Maneuver
face the patient and warm your hands Place your hands on the patients abdomen Determine what fetal part is at uterine fundus Curl your fingers around the fundus When the fetus is in the vertex position (head first) buttocks should feel irregular shape and firm When the fetus is in breech position, the head should feel hard, round and movable

Second Maneuver
Move your hands down the side of the abdomen Applying gentle pressure  If the fetus is in vertex position, youll feel a smooth, hard surface on one side- the fetal back Opposite, youll feel lumps and knobs- the knees, hands, feet, and elbow  If the fetus is in the breech position, you may not feel the back at all

Third Maneuver
Spread apart your thumb and fingers of one hand. Place them just above the patients symphysis pubis Bring your hand together  If the fetus is in the vertex and has descended, youll feel a less distinct mass  If the fetus is in the breech position, youll also feel a less distinct mass, which could be the feet or knees.

 The fourth maneuver can determine flexion or extension of the fetal head and neck Place your hands on both sides of the lower abdomen Apply gentle pressure with your fingers as you slide your hands downward, toward the symphysis pubis If the head is in the presenting fetal part (rather than the feet or a shoulder), one of your hands is stopped by the cephalic prominence. The other hand descends unobstructed more deeply If the fetus is in the vertex position, youll feel the cephalic prominence on the same side as the small parts; if its in the face position the same side as back If the fetus is engaged, you wont be able to feel the cephalic prominence.

Fourth Maneuver

Station
Fetal station is the position of the fetal presenting part and its descent into the pelvis...how far has the fetus descended...the ischial spines of the maternal pelvis are used to describe 0 station.

Fetal Lie
The fetal lie is described by the relationship of the long axis of the fetus to the long axis of the mother. This is a vertical lie. It is the most common fetal lie

Transverse
This picture shows the transverse lie of the fetus. This is a problem with a term baby and labor approaching

Oblique
This is a picture of an oblique lie of the fetus and is a problem in a term pregnancy

 Leopolds maneuver are intended to be performed by health care professionals As long as care is taken not to roughly or excessively disturb the fetus, there is no reason it cannot be performed at home as an information exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine fetal lie

Cautions

END
Thank You and God Bless