Introduction

Leopold maneuver is used to determine the lie, presentation, position, engagement of fetus. It is done by palpation(method of physical examination). palpation should be conducted with utmost gentleness. Clumsy and purposeless palpation is not only uninformative but may cause undue uterine irritability. During Braxton-Hicks contraction or uterine contraction in labour, palpation should be suspended.

Obstetric grips are as follows-

  1. Fundal Grip/Fundal palpation/ First Maneuver (First Leopold)
  2. Lateral Grip/Umbilical Grip/ Second Maneuver (Second Leopold)
  3. Pawlik’s Grip/ Third Maneuver/ Second Pelvic Grip (Third Leopold)
  4. Pelvic Grip/ Fourth Maneuver/First Pelvic Grip(Fourth Leopold)

Preparation steps

  • Woman’s /Mother’s/ Patient’s bladder should be empty.
  • Explain procedure to the woman to gain her confidence.
  • Woman’s abdomen is completely exposed from just below the breast to symphysis pubis.
  • Relaxed the abdominal muscle by placing a pillow under her head.
  • Be sure our hand are warm.
  • Before palpating lightly rest our hands on mother’s abdomen.

Technique/ Procedure

  1. Fundal Grip/Fundal palpation (First Leopold)
    • Palpation is done facing the patient’s face.
    • Place both hand on the woman’s fundus and curve the finger around the top of fundus.
    • Palpate for shape, size, and mobility of the fetal part in fundus.
    • If feel broad, soft and irregular that is breech presentation.
    • If feel smooth, hard and globular mass that is head.
    • If no part feels that is transverse lie.
  2. Lateral Grip/Umbilical Grip/ Second Maneuver (Second Leopold)
    • Palpation is done facing the patient’s face.
    • Hands are to be placed flat on either side of umbilicus to palpate one after the another .
    • The sides and front of the uterus to find out the position of the back, limbs and anterior shoulder.
    • While doing palpation gently pressure is put, pushing the fetus to other side, with pressure on one side the other side is palpated.
    • A small, curved and resistant feel suggestive of fetal back.
    • Feel of small knob like irregular mass suggestive of fetal limbs.
    • another method to locate the fetal back is by walking the finger tips of both hands over the abdomen.
  3. Pawlik’s Grip/ Third Maneuver/ Second Pelvic Grip (Third Leopold)
    • In this examiner position towards feet of mother but still facing the mother’s face.
    • Before examination instruct mother to bent her knees so, that abdomen is relaxed.
    • Grasp the lower pole of uterus above the symphysis pubis between thumb and fingers.
    • If presenting part is not engaged a movable mass is felt.
    • If engagement has occurred their is no movable mass felt by examinar.
    • In transverse lie Pawlik’s grip is empty.
  4. Pelvic Grip/ Fourth Maneuver (Fourth Leopold)
    • Palpation is done facing towards the mother’s feet and the knees of mother are bent.
    • Place hands on the side of uterus with the palm of our hand just below the level of umbilicus and our finger directed towards the symphysis pubis.
    • Press deeply into lower abdomen.
    • In this grip the engagement is ascertained by convergent and divergent of fingertips during palpation.
    • If both hands in convergent direction means no engagement.
    • If both hands are divergent means process of engagement is completed.
    • In both grips mentioned above mainly engagement of presenting part is tested.

Leave a Reply

Your email address will not be published. Required fields are marked *