3.) Leopold Maneuvers

Question 1

What is Leopold maneuvers ?

Answer 1

It’s a set of 4 abdominal palpation techniques used to assess the fetal position, presentation and engagement in the maternal pelvis.

Question 2

When can it be performed?

Answer 2

It can be performed after 24 weeks gestation however the ideal time is between 30 to 36 weeks when the fetal outline is more palpable.

Question 3

Predict where the fundus will be in the following circumstances:

At 12 weeks
At 20 weeks
At 36 weeks

Answer 3

At 12 weeks : The fundus is just above the symphisis pubis.

At 20 weeks : The fundus is at the level of the umbilicus.

At 36 weeks : The fundus reaches the xiphoid process.

Question 4

What happens to the fundal height after 36 weeks ?

Answer 4

It starts regressing by about 4cm as the baby starts descending into the pelvis.

Question 5

What happens to the fundal height post birth?

Answer 5

After childbirth the fundal height drops to the level of the umbilicus within one hour , it decreases by 1 cm per day and after about 10 days the fundus is no longer palpable.

Question 6

What is the first maneuver ?

Answer 6

Fundal Grip : it’s purpose is to determine what fetal part is in the fundus the head or buttocks. The head feels firm round and mobile while the buttocks are soft irregular and less mobile.

Question 7

What is the second maneuver ?

Answer 7

Umbilical grip : this helps identify the position of the fetal back. This is important for monitoring fetal heart rate as its best heard over the fetal back.

Question 8

What is the name of the 3rd maneuver ?

Answer 8

Pawlicks grip : to palpate the area above the pubic symphysis to assess if the fetal head is engaged in the pelvis if engaged the head should feel firm.

Question 9

What is the name of the 4th maneuver ?

Answer 9

Pelvic grip : this assesses how far the head has descended into the maternal pelvis and if it’s engaged or not it also determines fetal attitude.

If the head is flexed you will feel more of the occiput ( back of the head ) if extended then you will feel the forehead (sinciput) which means the head is tilted back,

flexed head is normal and known as vertex position

Question 10

What are the contraindications for the Leopold maneuvers ?

Answer 10

• Polyhydramnios : excessive amniotic fluid makes it difficult to palpate the uterus.
• Full bladder : this can distort the uterus and cause discomfort.
• Obesity.
• Supine position : lying Flat can lead to maternal hypotension the patient’s shoulders should be slightly elevated.
• Cold hands.
• Improper technique : Use palms instead of fingertips.