A skilled nurse should execute the procedure and care should be taken not to disturb the fetus in an excessive manner. The method can be painful for the expectant mother if the nurse performing the maneuvers is does not take care to perform the procedure properly. The maneuvers should be performed in a manner that is comfortable to the expectant mother.
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Examination Chapter. From Related Chapters. Page Contents Exam: Leopold's Maneuvers First Maneuver Upper pole Examiner faces woman's head Palpate uterine fundus Determine what fetal part is at uterine fundus Second Maneuver Sides of maternal Abdomen Examiner faces woman's head Palpate with one hand on each side of Abdomen Palpate fetus between two hands Assess which side is spine and which extremities Third Maneuver Lower pole Examiner faces woman's feet Palpate just above Symphysis Pubis Palpate fetal presenting part between two hands Assess for Fetal Descent Fourth Maneuver Presenting part evaluation Examiner faces woman's head Apply downward pressure on uterine fundus Hold presenting part between index finger and thumb Assess for cephalic versus Breech Presentation.
Images: Related links to external sites from Bing. This position is also known as an occiput position or it's sometimes nicknamed "sunny-side-up.
This position could increase your chances of a painful and prolonged delivery. A breech position means that your baby's bottom is facing downwards. There are three different breech positions:. Any of these positions can make for a riskier delivery so you are at risk of a C-section delivery if the baby doesn't change position before labor.
Your baby might also be in a transverse lie position at the end of the third trimester, which means they are lying sideways across your uterus instead of vertically. If they don't change position, it could make for dangerous labor, so a C-section will be required. Fetal weight estimates help your healthcare provider plan for birth, too. In general, a baby who is estimated to be 10 pounds or more might require a C-section birth because your baby could get caught in the birth canal.
There are no known risks for using Leopold Maneuvers, as long as they are being performed by qualified medical professionals.
However, they are not always accurate at determining the position or estimated weight of your baby before the 36th week of your pregnancy. So, your medical provider will not likely use them before your week checkup. For your own comfort, your provider will likely ask you to pee before they do the procedure, because a full bladder can make it difficult to really determine your baby's position with accuracy. Your provider might also not use these maneuvers if you were in an accident.
Leopold maneuvers are very accurate, but it is possible that your healthcare provider will still perform an ultrasound prior to your delivery to confirm your baby's position, particularly if they are concerned that your baby is in a transverse or breech position. Leopold Maneuvers are difficult to perform on people who are obese because it is difficult to feel the baby's position. They are also more complicated to perform on patients who have polyhydramnios , which is when you have too much amniotic fluid surrounding your baby, as well as people with fibroids.
Leopold maneuvers are usually performed after 36 weeks by your healthcare provider to determine your baby's position and estimate their birth weight. This will help you and your provider be better prepared for your labor and determine if it might be safer to perform a c-section.
The maneuvers should not hurt and they are very accurate, though your provider might still perform an ultrasound to confirm any findings. Leopold's Maneuvers Leopold's maneuvers 1 consist of an abdominal examination divided into four steps of palpation of the gravid uterus and fetus Fig.
The examiner may be able to palpate the presenting part. In addition, a clinical estimate of the degree of engagement of the presenting part could be made, although the final determination of engagement must be made by way of a vaginal examination.
Through use of Leopold's maneuvers, a clinical estimate of the fetal weight also can be obtained, although this is not a formal part of this examination. The accuracy of Leopold's maneuvers can be hampered by the maternal body habitus, the presence of uterine fibroids, multiple gestations, or polyhydramnios.
What follows is a description of these maneuvers:. Leopold's maneuvers. The fetus is in a left occiput anterior position. New York, Appleton-Century-Crofts, Maneuver I: The uterine contour is outlined. The fundus is palpated with the fingertips of both hands facing toward the maternal xiphoid cartilage. This should allow the identification of the fetal parts in the upper pole fundus of the uterus.
Maneuver II: Once an assessment is made of the fetal part present in the uterine fundus, the hands are placed at either side of the maternal abdomen. With this maneuver, the examiner will be able to determine the location of the fetal back. Maneuver III: Using one hand, the examiner will grasp the presenting part between the thumb and fingers.
This is done on the lower abdomen, a few centimeters above the symphysis pubis. This will allow the examiner to develop a further identification of the presenting part and assessment of its engagement. Maneuver IV: This last maneuver resembles the first one, but instead of facing the fundus, the examiner faces the pelvis of the patient.
The palms of both hands are placed on either side of the lower maternal abdomen, with the fingertips facing toward the pelvic inlet.
This maneuver should allow the identification of the fetal parts in the lower pole of the uterus. After the abdominal examination, a digital vaginal examination is performed. The status of the amniotic membranes and the degree of engagement of the presenting part are indicators of fetal presentation and position. The vaginal examination also allows the clinician to assess the degree of cervical dilation and effacement.
If the presenting part is not easily palpable, it is important that further assessment be obtained by performing an ultrasound examination.
Fetal Lie Using the techniques described above, the clinician should be able to develop an assessment of the relationship between the fetal and maternal dorsal columns the longitudinal axis of the human body. If the fetus and maternal column are parallel on the same long axis , the lie is termed vertical or longitudinal lie. This is the most common lie of fetuses in labor.
There are variants of these two lies, in which the fetus may be in transition from a vertical to a transverse lie. These are the oblique lies. A fetus can be in an unstable or variable lie when the head is completely unengaged and floating. This situation is seen mostly in cases of severe polyhydramnios and prematurity. The obstetrician should be aware that a fetus in this particular type of lie is susceptible to a cord accident if the patient is in active labor and her cervix is dilating.
Attitude In addition to having a lie, the fetus has an attitude. This is defined as the relation of the various parts of the fetus to each other. In the normal attitude, the fetus is in universal flexion. The anatomic explanation for this posture is that it enables the fetus to occupy the least amount of space in the intrauterine cavity. The fetal attitude is extremely difficult, if not impossible, to assess without the help of an ultrasound examination. Presentation After the lie of the fetus is assessed, the clinician has to detail the fetus further by describing the lowermost structure of the fetus in the maternal pelvis.
This is referred to as the fetal presentation. In a vertical or longitudinal lie, the fetal presentation can be either cephalic or breech.
In the transverse lie, the presentation is usually the back or shoulder; in the oblique lie, it is usually the shoulder or the arm. The cephalic presentation can be further categorized based on the degree of flexion of the fetal head: A well-flexed head is described as a vertex presentation , an incomplete flexion as a sinciput presentation , a partially extended deflexed head as a brow presentation , and a complete extension of the head as a face presentation.
Breech presentation can be categorized on the basis of the attitude or flexion of the hip and knee joints. If there is flexion at the hip and extension at the knees, the fetus is a frank breech. If there is flexion at both the hip and knee joints, the fetus is a full or complete breech. A footling breech has one or both hips and knees in a partial or intermediate extension; this fetus is sometimes called an incomplete breech. Presentations other than cephalic or breech in a singleton pregnancy require an abdominal route of delivery.
Abnormal presentations occur more often in cases of multiple gestation, usually affecting the second twin. Depending on the clinical condition, vaginal delivery of a malpresenting second twin is possible. Position The next step in the assessment of the fetus consists of determining the position of the presenting part. This is a description of the relation of the presenting part of the fetus to the maternal pelvis. In the case of a longitudinal lie with a vertex presentation, the occiput of the fetal calvarium is the landmark used to describe the position.
When the occiput is facing the maternal pubic symphysis, the position is termed direct occiput anterior. If the occiput is between the ischial spines and the symphysis, it is called either a right or left occiput anterior. If the occiput is located halfway between the promontorium of the sacrum and the symphysis, the position is termed either a left or right occiput transverse.
As the occiput approaches the sacrum, it becomes either a right or left occiput posterior. When the occiput is straight down i. This method of describing the fetal position can be applied to other presentations by substitution of the vertex for the presenting fetal anatomic landmark. In cases of breech presentation, the fetal sacrum is used for position. With transverse and oblique lies, the shoulder structures acromion can be used for the description of position.
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