The LEOPOLD MANEUVERS in Midwifery practice

Leopold's Maneuver

1. LEOPOLD’S MANEUVERS EDGAR A. ULEP, RM, LPT, MSPH. Midwifery Department Quirino State University – Cabarroguis Campus

2. INTENDED LEARNING OUTCOME Students demonstrate understanding and execute the Leopold’s maneuver procedure.

3. LEOPOLD MANEUVERS Are systematic method of observation and palpitation of abdomen to determine fetal presentation, position and engagement. Leopold’s Maneuver is preferably performed after 24 weeks gestation when fetal outline can be already palpated.

4. CONTRAINDICATIONS:LEOPOLD MANEUVERS FETAL ATTITUDE Describes the degree of flexion a fetus assumes during labor or the relation of the fetal parts to each other. TYPES: Full or complete flexion (Vertex) good attitude Normal attitude in cephalic presentation. This allows the smallest cephalic diameter to enter the pelvis Moderate flexion ( Sinciput ) military attitude 90 degree angle, as if the baby is looking straight forward. Partial extension (brow) Face presentation maximally extended Complete extension (Face) poor flexion Rare unanticipated obstetric event characterized by a longitudinal. Fetal head on the neck with the occiput against the upper back

5. FETAL LIE Is the relationship between the long ( Cephalocaudal ) axis of the fetal body and the long ( Cephalocaudal ) axis of woman’s body; in other words, whether the fetus is lying in a horizontal (Transverse) or a vertical (Longitudinal) position

6. FETAL PRESENTATION Denotes the body part that will first contact the cervix TYPES: Cephalic presentation Breech presentation Shoulder presentation

7. CEPHALIC PRESENTATION TYPES: Vertex Brow Face Chin ( Mentum )

8. BREECH PRESENTATION TYPES: Complete Frank Footling

9. TRANSVERSE LIE/SHOULDER PRESENTATION TYPES: Shoulder Iliac crest Hand Elbow Note: Cesarean delivery

10. FETAL POSITION Is the relationship of the presenting part to a specific quadrant of the woman’s pelvis. 4 LANDMARKS: Vertex-Occiput (O) Face-Chin/ Mentum (M) Breech-Sacrum (Sa) Shoulder-Scapula/Acromion process (A)

11. FETAL ENGAGEMENT Settling of the fetal head into the pelvis Descent of the presenting part of the fetus midpoint of the pelvis

12. SPECIAL CONSIDERATION Preparation: Instruct woman to empty her bladder first. Place woman in dorsal recumbent position, supine with knees flexed to relax abdominal muscles. Place a small pillow under the head for comfort. Drape properly to maintain privacy Wash hands using warm water Explain procedure to the patient. Warms hands by rubbing together. (Cold hands can stimulate uterine contractions). Use the palm for palpation not the fingers.

13. 1 st Maneuver: FUNDAL GRIP Face the client’s head Place your hands on the fundal area and palpate around the fundus WHAT IS THE PURPOSE? To determine fetal part lying in the fundus To determine presentation FINDINGS? HEAD is more firm, hard and round that moves independently of the body. BREECH is less well defined that moves only in conjunction with the body Expecting to palpate a soft, irregular mass in the upper quadrant of the maternal abdomen

14. 1 st Maneuver: FUNDAL GRIP Determine which part of the fetus is in the fundus If palpated a soft mass, irregular shape and difficult to move FETAL BUTTOCKS

15. 2 nd Maneuver: UMBILICAL GRIP Locate the back of the fetus in relation to the right and left side of the mother. Still facing the client, place the palmar surfaces of the both hands on either side of the abdomen and apply gentle but deep pressure. If the hand of one side of the abdomen remains still to steady the uterus, a slightly circular motion with the flat surface of the fingers on the other hand can gradually palpate the opposite side from the top to the lower segment of the uterus to feel the fetal outline. To palpate the other side, the functions of the hands are reversed. On the fetal back, smooth, hard resistant place will be felt; side with fetal extremities will feel nodular, reflecting portions of fetal extremities WHAT IS THE PURPOSE? To identify location of fetal back. To determine position FINDINGS? FETAL BACK is smooth, hard, and resistant surface KNEES AND ELBOWS of fetus feel with a number of angular nodulation You will palpate round nodules on one side, and feel smooth on the other side

16. 3 rd Maneuver: Pawlick’s Grip Gently grasp the lower portion of the abdomen, just above the symphysis pubis between the thumb and the fingers of one hand. Then press together WHAT IS THE PURPOSE? To determine engagement of presenting part. FINDINGS? The presenting part is not engaged if it is not movable. It is not yet engaged if it is still movable. Grasp the presenting part with the thumb and third finger

17. 3 rd Maneuver; Pawlick’s Grip Determine the presenting part / confirms fetal position Round, firm and ballotable on palpation UNENGAGED FETAL HEAD

18. 4 th Maneuver; Pelvic Grip Face the client’s feet The tips of the first 3 fingers are placed on both sides o the midline about 2 inches above the Poupart’s ligament. Pressure is now made downward and the direction of the birth canal, the movable skin of the abdomen being carried downward along with fingers. The fingers of one hand meet no obstruction and be carried down ward well under Poupart’s ligament. These fingers glide over the nape of the baby’s neck. The other hand however usually meets an obstruction an inch or so above the Pouparts’s ligament. This is the brow of the baby and is usually spoken of as the cephalic prominence. WHAT IS THE PURPOSE? To determine the fetal attitude and the degree of fetal extension into the pelvis. It should be done only if the fetus is in cephalic presentation. Then try to move your hands toward each other while applying downward pressure

19. 4 th Maneuver; Pelvic Grip Used in the late stage of pregnancy to determine how far the fetus has descended into the pelvic inlet If the hands move together easily FETAL HEAD HAS NOT DESCENDED INTO THE PELVIC INLET Used in the late stage of pregnancy to determine how far the fetus has descended into the pelvic inlet If the hands do not move together and stop to resistance met FETAL HEAD IS ENGAGED INTO THE PELVIC INLET

20. Abnormal Findings Oblique or transverse lie needs to be noted If vaginal delivery is expected, external version can be performed to rotate the fetus to the longitudinal lie fetal spine axis is parallel to the maternal spine axis Breech or shoulder presentations can complicate delivery if it is expected to be vaginal

21. THANK YOU EDGAR A. ULEP, RM, LPT.