Question

1. Why is learning to perform Leopold's maneuvers important?
2. what can you learn from this procedure?
3. What would contraindications be to performing this maneuver?

Answer 1

1. Leopold's maneuvers are a systemic way to identify the position of the fetus inside the uterus. This procedure is important in obstetrics for the identification of the positioning and lie of the fetus in which the correct assessment of the shape of the maternal pelvis will indicate the delivery mode, whether the delivery will be complicated or a cesarean will be necessary.
2. Leopold's maneuvers procedure is used to determine the position of the fetus. The procedure consists of four distinct actions that will help to determine the position of the fetus.

a) First maneuver- Fundal grip: In this, palpation will do to the women’s upper abdomen with both hands to determine the size, shape, consistency, and mobility of the fetus lying in the fundus. The fetal head feels hard and round while the buttocks feel softer and are symmetric in nature, and small bony processes in the shoulders and limbs.

b) Second maneuver- Umbilical grip: This method is used to determine the fetal back. Gentle palpation on the abdomen with deep pressure using the palms of the hands. The right hand will keep steady on one side of the abdomen and with the left hand-inspect, the right side of the uterus and the procedure will be repeated on the opposite side and hands. The fetal back will feel firm and smooth and the fetal extremities will feel like some protrusions.

c) Third maneuver- First Pelvic grip or Pawlik grip: This procedure is to determine what fetal part is lying in the lower abdomen. The maneuver can be performed by grasping the lower portion of the abdomen with the thumb and fingers of the right hand to determine the engagement of the presenting part.

d) Fourth maneuver- Leopold’s second pelvic grip: This procedure is to determine the degree of the flexion of the fetal head and to identify the attitude or habitus. This can be performed by facing the foot part of the woman and with both hands, palpate the fetal head pressing downward about 2 inches above the inguinal ligament. If the fetal head is well flexed, the brow is located on the opposite side of the back and if the head is hyperextended then the brow is on the same side of the back.

1. Contraindications

It is difficult to perform this maneuver in:

• Women with pregnancy complicated polyhydramnios
• Obese pregnant women
• Presence of fibroids
• Anti-placental location