Obstetrics Book

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Leopold's Maneuvers

Aka: Leopold's Maneuvers, Fetal Orientation
  1. See Also
    1. Fetal Malpresentation
  2. Exam: Leopold's Maneuvers
    1. First Maneuver (Upper pole)
      1. Examiner faces woman's head
      2. Palpate uterine fundus
      3. Determine what fetal part is at uterine fundus
    2. Second Maneuver (Sides of maternal Abdomen)
      1. Examiner faces woman's head
      2. Palpate with one hand on each side of Abdomen
      3. Palpate fetus between two hands
      4. Assess which side is spine and which extremities
    3. Third Maneuver (Lower pole)
      1. Examiner faces woman's feet
      2. Palpate just above symphysis pubis
      3. Palpate fetal presenting part between two hands
      4. Assess for Fetal Descent
    4. Fourth Maneuver (Presenting part evaluation)
      1. Examiner faces woman's head
      2. Apply downward pressure on uterine fundus
      3. Hold presenting part between index finger and thumb
      4. Assess for cephalic versus Breech Presentation
  3. Exam: Focus areas for abdominal palpation
    1. Assess Fundal Height
      1. Fundal height (cm) approximates weeks of gestation
    2. Assess Fetal Lie
      1. Longitudinal (Normal)
      2. Transverse
      3. Oblique
    3. Assess Fetal Presentation
      1. Breech Presentation
      2. Cephalic Presentation
        1. Vertex Presentation (Normal attitude: Full flexion)
        2. Face Presentation (Abnormal attitude: Head extends)
    4. Assess Fetal Vertex Position
      1. Palpate the sagittal Suture (may be obscured by caput)
        1. Anterior Fontanelle has 4 adjacent Suture lines
        2. Posterior Fontanelle has 3 adjacent Suture lines
      2. Palpate ear position
      3. Positions
        1. Left Occiput Lateral (LOL) 40%
        2. Left Occiput Anterior (LOA) 12%
        3. Left Occiput Posterior (LOP) 3%
        4. Right Occiput Lateral (ROL) 25%
        5. Right Occiput Anterior (ROA) 10%
        6. Right Occiput Posterior (ROP) 10%
    5. Assess Fetal Descent
      1. Is Vertex engaged?
  4. Other methods of determining Fetal Orientation
    1. Obstetric Ultrasound
    2. Digital cervical exam

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