Leopold's Maneuver

Leopold·s Maneuver

Learning Objective Understand Leopold·s Maneuver , Purpose and OutcoAme

Leopold·s 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

examiner·s 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.

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. 

The

Abdominal Palpation 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. 

The

Reminder  Patient should empty her bladder  Examiner·s hand should be warm  Explain the procedure to the patient  Provide client·s 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

First

Maneuver

 face the patient and warm your hands  Place your hands on the patient·s 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, you·ll feel a smooth, hard surface on one side- the fetal back  Opposite, you·ll feel lumps and knobsthe knees, hands, feet, and elbow  If the fetus is in the breech position, you may not feel the back at all

Third 

Spread hand.

Maneuver

apart your thumb and fingers of one

 Place them just above the patient·s symphysis pubis  Bring your hand together  If the fetus is in the vertex and has descended, you·ll feel a less distinct mass  If the fetus is in the breech position, you·ll also feel a less distinct mass, w hich could be the feet or knees.

Fourth

Maneuver

 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, you·ll feel t he cephalic prominence on the same side as the small parts; if it·s in the face position the same side as back  If the fetus is engaged, you won·t be able to feel the cephalic prominence.

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

T ransverse 

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

Cautions

 Leopold·s maneuver are intended to be performed by health care professionals  As long as care is taken not to roughly or excessively disturb t he 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

END Thank

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