Leopold’s maneuvers are a systematic method of observation and palpation to

determine fetal presentation and position. It is usually done by placing two hands on
the pregnant uterus to determine the position of the fetus and it's possible size.

PROCEDURES:

1. Prepare the client.

a. Explain the procedure.

b. Instruct the client to empty her bladder.

c. Position the woman supine with knees slightly flexed. Place a small pillow or rolled
towel under one side.

d. Wash your hands using warm water.

e. Observe the woman’s abdomen for longest diameter and where fetal movement is
apparent.

2. Perform the First maneuver.

a. Stand at the foot of the client, facing her, and place

both hands flat on her abdomen.

b. Palpate the superior surface of the fundus.

Determine consistency, shape, and mobility.

3. Perform the Second maneuver.

a. Face the client and place the palms of each hand

on either side of the abdomen.

b. Palpate the sides of the uterus. Hold the left hand

stationary on the left side of the uterus while the right
hand palpates the opposite side of the uterus from top
to bottom. Then hold the right hand steady, and
repeat palpation using the left hand on the left side.
4. . Perform the Third maneuver.

a. Gently grasp the lower portion of the abdomen just

above the symphysis pubis between the thumb and
index finger and try to press the thumb and finger
together. Determine any movement and whether the
part is firm or soft.

5. Perform the Fourth maneuver.

a. Place fingers on both sides of the uterus

approximately 2 inches above the inguinal ligaments,
pressing downward and inward in the direction of the
birth canal. Allow fingers to be carried downward.

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Principle ( kung gusto niyo lng ilagay hahah i-align nyo lng sa
steps parang rationale kasi to)

a. Explanation reduces anxiety and enhances cooperation.

b. Doing so promotes comfort and allows for more productive palpation because fetal
contour will not be obscured by a distended bladder.

c. Flexing the knees relaxes the abdominal muscles. Using a pillow or towel tilts the
uterus off the vena cava, thus preventing supine hypotension syndrome.

d. Handwashing prevents the spread of possible infection. Using warm water aids in
client comfort and prevents tightening of abdominal muscles.

e. The longest diameter (axis) is the length of the fetus. The location of activity most
likely reflects the position of the feet.

2. This maneuver determines whether fetal head or breech is in the fundus.

a. Proper positioning of hands ensures accurate findings.

b. When palpating, a head feels more firm than a breech. A head is round and hard; the
breech is less well defined. A head moves independently of the body; the breech moves
only in conjunction with the body.

3. This maneuver locates the back of the fetus.

a. Proper positioning of hands ensures accurate findings.

b. This method is most successful to determine the direction the fetal back is facing.
One hand will feel a smooth, hard, resistant surface (the back), while on the opposite
side, a number of angular nodulations (the knees and elbows of the fetus) will be felt.

Purpose: Systematically observing and palpating the abdomen to determine fetal

presentation and position
4. This maneuver determines the part of the fetus at the inlet and its mobility.

a. If the presenting part moves upward so an examiner’s hands can be pressed

together, the presenting part is not engaged (not firmly settled into the pelvis). If the part
is firm, it is the head; if soft, then it is the breech.

5. This maneuver determines fetal attitude and degree of fetal extension into the pelvis;
it should be done only if the fetus is in a cephalic presentation. Information about the
infant’s anteroposterior position may also be gained from this final maneuver.

a. The fingers of one hand will slide along the uterine contour and meet no obstruction,
indicating the back of the fetal neck. The other hand will meet an obstruction an inch or
so above the ligament—this is the fetal brow. The position of the fetal brow should
correspond to the side of the uterus that contained the elbows and knees of the fetus. If
the fetus is in a poor attitude, the examining fingers will meet an obstruction on the
same side as the fetal back. That is, the fingers will touch the hyperextended head. If
the brow is very easily palpated (as if it lies just under the skin), the fetus is probably in
a posterior position (the occiput is pointing toward the woman’s back).