Leopold’s maneuvers: Palpating for Fetal presentation
The four Leopold’s maneuvers are:
1. First Maneuver
– to determine presenting part at the fundus
- head is more firm, hard and round that moves independently of the body
- Breech is less well defined that moves only in conjunction with the body
2. Second Maneuver
– to determine fetal back
– one hand: will feel smooth, hard resistant surface (the back)
– the opposite side, a number of angular nodulation (knees and elbows of fetus)
3. Third Maneuver
– to determine position and mobility of presenting part by grasping the lower portion of the abdomen (just above the symphysis pubis).
– if the presenting part moves upward so the examiner’s hand can be pressed together, then presenting part is not engaged
4. Fourth Maneuver
– to determine fetal descent
– fingers are pressed in both side of the uterus approximately 2 inches above the inguinal ligaments, then press upward and inward.
– the fingers of the hand that do not meet obstruction palpates the fetal neck, as the fingers of the other hand meet an obstruction above the ligaments palpates the fetal brow.
– Good attitude if brow correspond to the side (2nd maneuver) that contained the elbows and knees.
– Poor attitude if examining fingers will meet an obstruction on the same side as fetal back (hyperextended head).
– also palpates infant’s anteroposterior position. If brow is very easily palpated, fetus is at posterior position (occiput pointing towards woman’s back).
Assessing fetal descent: