LEOPOLDS MANEUVER Definition: Four maneuvers in diagnosing the fetal position by external palpation of the abdomen.

Purpose: To determine fetal presentation and position and the expected location of the point of maximal intensity (PMI) of fetal heart rate (FHR) in the womans abdomen. Indication: For pregnant woman with palpable fetus usually performed starting from the middle of pregnancy. Contraindication: A full bladder may obscure the findings Special Considerations: mothers

1. Obese clients have thick belly fat which can also obscure the findings.
2. Patients who are polyhydramnios may give the examiner a little difficulty; however reassessment and rechecking of another nurse and intravaginal examination (IE) can help to confirm the findings. PROCEDURE THE RATIONALE PATIENT Explanation reduces anxiety and enhances cooperation

A. PREPARE

1. Explain the procedure to the client. 2. Instruct the client to empty her bladder Promotes comfort and allows for more

productive palpation because the fetal contour will not be obscured by a distended bladder

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

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

4. Wash water

your

hands

using

warm

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

5. Observe the woman's abdomen for longest diameter and where fetal movement is apparent

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

PROCEDURE B. PERFORM THE FIRST MANEUVER 1. Stand at the foot of the client, facing her, and place both hands flat on the abdomen.

RATIONALE Proper positioning of hands ensures accurate findings

2. Palpate the superior surface of the fundus. Determine the consistency, shape, and mobility

To determine what position of the fetus lies in the fundus. Head feels round and hard, freely movable and ballotable, breech feels large, nodular and softer

C. PERFORM THE SECOND MANEUVER 1. Face the client and place the palms of your hands on both sides of the abdomen.

Proper positioning of hands ensures accurate findings

2. Palpate the sides of the uterus. To determine which direction the fetal head is
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. facing. If one hand feels a smooth, hard, long, continuous structure it is the back. If the other hand feels the nodular angulations it is the extremities of the fetus.

D. PERFORM THE THIRD MANEUVER 1. 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 your index finger together.

Determines

the

presenting

part

and

its

mobility. If the presenting part moves upward so an examiners hands can be pressed together, the presenting part is engaged ( not firmly settled into the pelvis)

2. Determine

any

movement

and

If the part is firm, it is the head; if it is soft, then it is the breech.

whether the part is firm or soft.

PERFORM THE FOURTH MANEUVER 1. Place fingers on both sides of the uterus approximately 2 inches above the of inguinal the ligaments, birth pressing canal downward and inward to the direction

This maneuver determines fetal attitude and degree of fetal extension into the pelvis should only be done if fetus is in cephalic position. Information about the infants anteroposterior position may be gained from this final maneuver.

PROCEDURE

E. Place your client in a comfortable position.

F. Document procedure. procedure and assessment

RATIONALE To ensure safety and comfort of the client Documentation communication serves and as a of means care of and

findings and the clients response to the

basis

evaluation of patient outcomes.