Question

Discuss the techniques and assessment of a pregnant adult female abdomen: Leopold’s maneuver.

Answer 1

A through and systemic abdominal examination beyond 28 weeks of pregnancy can reasonably diagnose the lie, presentation, position and attitude of the fetus. It is unlikely that the lie and the presentation of the fetus might change, specially in association with excess liquor amni and hence periodic check up essential.

Leopold’s Maneuvers, named after Christian Gerhard Leopold,a German Obstetrician, are methods to determine position, presentation and engagement of fetus.

The maneuvers have four specific actions that nurses must perform.

Use.

Nurses use this process along with the assessment of the maternal pelvis’ shape to determine if complications will occur during the delivery and if the patient will require a Cesarean section.

Preliminaries

The patient is asked to evacuate the bladder. She is then made to lie in dorsal position with the third slightly fixed. Abdomen is fully exposed.

The examiner stands on the right side of the patient.

The examiner warm hands, and apply them to the mother’s abdomen with firm and gently pressure.

1) Instruct the client (pregnant mother) to empty the bladder before performing the maneuver ( Rationale : she will be comfortable and the contour of the fetus is not obscured.)

2) Drape the client and place a pillow under her head.( Rationale: for maintaining client privacy)

3) Explain the procedure to the client and answer any questions that she may have.

4) Make sure that the hands are warm before coming in contact with the patient’s abdomen. Rub the hands together vigorously to prevent uterine contractions.

5) Use the palm of the hand instead of the fingers.

6) The nurse should stand with the body facing the client during the first three maneuvers and facing the feet of the patient during the final maneuver.

7) During Braxton-Hicks contraction or uterine contraction in labour, palpation should be suspended.

8) Palpation should be conducted with atmost gentleness.

9) Clumsy and purposeless palpation is not only uninformative but may cause undue uterine irritability.

Steps.

1.Maneuver One: Fundal Grip

The palpation is done facing the client's face.

The whole of the fundal area is palpated using both hands laid flat on it to find out which pole of the fetus lying in the fundus.

The nurse should use this method to determine the shape, size, mobility, and consistence of what he or she feels.

The nurse should feel that the limbs and shoulders contain little bone processes that move with the fetus’ trunk.

The head is firm, hard, round and moves separately from the trunk.

The buttocks is symmetric and feels soft.

• Broad , soft and irregular mass suggestive of breech.
• Hard and globular mass suggestive of head
• In transverse lie neither the fetal poles are palpated in the fundal area.

2. Maneuver Two: Umbilical Grip or lateral grip

After the nurse identifies the form and palpates the upper abdomen, the location of the fetus’ back must be identified.

This palpation is done facing the patients face.

The nurse should apply deep pressure with the palm of his or her hands to palpate the abdomen gently.

The hands are to be placed flat on either side of the umbilicus to palpate one after the other, the sides and front of the uterus to find out the position of the back, limbs and anterior shoulder.

Perform this maneuver by placing the right hand on one side of the patient’s abdomen while using the left hand to explore the woman’s uterus on the right side.

Repeat this step on the opposite side using the opposite hand.

• The nurse should observe that the fetal back is smooth and firm.
• The back is suggested by smooth curved and resistant feel.
• The limb side is comparatively empty and there the small knob like irregular parts
• The extremities of the fetus should feel like protrusions and small irregularities.
• The back should connect with the form felt in the lower (maternal inlet) and upper abdomen.
• After the identification of the back it is essential to note it's position whether placed anteriorly or towards the flank or placed transversely.
• Similarly, the disposition of the small parts , whether placed to one side or placed anteriorly occupying both the sided to be noted.
• The position of the anterior shoulder is to be sought for. It forms a well marked prominence in the lower part of the uterus above the head. It may be placed near midline or well away from midline.

3) Maneuver Three: Pawlick’s Grip

The examination is done facing towards the clients face.

The two- hand approach is an alternative that is more comfortable for the patient. Nurses can perform this approach by positioning the fingers of both hands in a lateral position on one side of the presented part.

The overstretched thumb and four fingers of the right hand are placed over the lower pole of the uterus keeping the ulnar border of the palm on the upper border of the symphysis pubis.

When the fingers and thumb are approximated , the presenting part is grasped distinctly, if not engaged and also the mobility from side to side is tested.

In transverse lie, Pawlik's grip is empty. This grip is known as third maneuver of Leopold.

• During this step of the process, the nurses must identify the part of the fetus that is above the inlet.
• The nurse must use the fingers and thumb on the right hand to grasp the lower abdomen area located above the pubic symphysis. The findings should validate what is determined in the first maneuver.

4. Maneuver Four: Pelvic Grip

This step should be done while facing the patient’s feet.

The process involves locating the fetus’ brow.

Four fingers of both hands are placed on either side of the midline in the lower pole of the uterus and parallel to the inguinal ligament. The fingers are pressed downwards and backwards in the manner of approximation of finger tips to palpate the part occupying the lower pole of the uterus.( The nurse should gently move the fingers on both hands toward the pubis by sliding the hands over the sides of the patient’s uterus, and the side where the greatest resistance to the descending fingers is the location of the brow)

Head

• If the presentation is head there will be precise presenting area, attitude and engagement
• A well-flexed fetal head is located on the opposite side of the fetal back.
• If the head is extended, the back of the head is felt on the side that the back is located.
• A head that cannot be felt has likely descended.

This grip is also known as Leopard fourth maneuver. This pelvic grip is using both hands is favoured, as it is the most comfortable for woman and gives more information.

Oostelnic Compos Frondal Grip. enten Tetenal Grip C second rogold Pelvic Grip (Forth Leopold Partick Grip (Third Leopold

Oostelnic Compos Frondal Grip. enten Tetenal Grip C second rogold Pelvic Grip (Forth Leopold Partick Grip (Third Leopold

Oostelnic Compos Frondal Grip. enten Tetenal Grip C second rogold Pelvic Grip (Forth Leopold Partick Grip (Third Leopold

Oostelnic Compos Frondal Grip. enten Tetenal Grip C second rogold Pelvic Grip (Forth Leopold Partick Grip (Third Leopold