How to Perform Leopold

7/30/2019 How to Perform Leopold

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|Prepared by: Lumba, Chared Joy D. 1

http://nursingcrib.com/nursing-notes-reviewer/maternal-child-health/how-to-perform-leopolds-maneuver/

Book: Maternal and Child Health Nursing Volume 1, Adele Pillitteri

Leopolds Maneuvers

Leopolds maneuvers are a systematic method of observation and palpation to determine fetal presentation

and position. It is preferably performed after 24 weeks gestation when fetal outline can be already palpated.

Preparation:

1. Explain procedure to the patient.2. Instruct woman to empty her bladder first.3. Place woman in supine position with knees slightly flexed to relax abdominal muscles. Place a small

pillow under the head for comfort.

4. Drape properly to maintain privacy.5. Wash your hands using warm water.6. Observe the womans abdomen for longest diameter and where fetal movement is apparent.7. Use the palm for palpation not the fingers.

Purpose Procedure Findings

First Maneuver:

Fundal Grip

To determine fetal

part lying in the

fundus.

To determine

presentation.

Stand at the foot of the client,

facing her, and place both hands

flat on her abdomen.

Palpate the superior surface of

the fundus. Using both hands,

feel for the fetal part lying in the

fundus.

Determine consistency, shape,

and mobility.

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.

Second

Maneuver:

Umbilical Grip

To identify location

of fetal back.

To determine

position.

Face the client and place the

palms of each hand on either

side of the abdomen.

Palpate the sides of the uterus.

One hand is used to steady the

uterus on one side of the

abdomen while the other handmoves slightly on a circular

motion from top to the lower

segment of the uterus to feel for

the fetal back and small fetal

parts.

Fetal back is smooth, hard, and

resistant surface.

Knees and elbows of fetus feel with a

number of angular nodulation.
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Use gentle but deep pressure.

Third

Maneuver:

Pawliks Grip

To determine

engagement of

presenting part.

To determine the

part of the fetus at

the inlet and itsmobility.

Using thumb and finger, gently

grasp the lower portion of the

abdomen above symphysis

pubis, press in slightly and make

gentle movements from side to

side.

Determine any movement and

whether the part is firm or soft.

The presenting part is engaged

(firmly settled into the pelvis) if it is

not movable.

It is not yet engaged if it is still

movable.

If the part is firm, it is the head.If the part is soft, it is the breech.

Fourth

Maneuver:

Pelvic Grip

*It should be

done only if the

fetus is in acephalic

presentation.

Information

about the

infants

anteroposterior

position may

also be gained

from this final

maneuver.

To determine the

degree of flexion of

fetal head.

To determine

attitude or habitus.

Facing foot part of the woman,

place fingers on both sides of the

uterus about 2 inches above the

inguinal ligament and palpate

fetal head pressing downward

and inward in the direction of

the birth canal.

Use both hands and allow fingersto be carried downward.

The fingers of one hand will slide

along the uterine contour and meet

no obstruction, indicating the back of

the fetal neck.

The other hand will meet an

obstruction an inch or so above the

ligament- this is the fetal brow.

Good attitude if fetal brow

corresponds to the side of the uterus

that contained the elbows and knees

of the fetus.

Poor attitude if examining fingers

will meet an obstruction on the same

side as fetal back (if the fingers will

touch the hyperextended head)

Also palpates infants anteroposterior

position. If brow is very easily

palpated, fetus is at posterior

position (occiput pointing towards

womans back)


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labspace.open.ac.uk/file.php/6634/!via/oucontent/.../x-ldcs1.docMechanisms (Cardinal Movements) of Labor

The seven cardinal movements are the series of positional changes made by the baby which assist its passage

through the birth canal. (Cardinal means fundamentally important.)

The positional changes made by the baby are specific, deliberate and precise. They allow the smallestdiameter of the baby to pass through the mother's pelvic cavity. Neither you nor the mother is responsible for

these positional changes. The baby has the responsibility for the seven cardinal movements.

1. EngagementEngagement is when the fetal head enters into the pelvic inlet. The head is said to be engaged when the

biparietal diameter(measuring ear tip to ear tip across the top of the babys head) descends into the pelvic

inlet, and the occiputis at the level of the ischial spines in the mothers pelvis.

Moulding of the fetal skull may occur during descent; in this example, one parietal bone is overlapping the

other at the sagittal suture. The occiput and the distance known as the bi-parietal diameter have been

labelled.


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5. ExtensionAfter internal rotation is complete, the babys head passes through the pelvis and a short rest occurs when the

babys neck is under the mothers pubic arch. Then extensionof the babys head and neck occur the neck

extends, so the chin is no longer pressed against the babys chest, and the top of the head, face and chin are

born.

6. External rotation (restitution)After the head of the baby is born, there is a slight pause in the action of labour. During this pause, the baby

must rotate so that his/her face moves from facing the mothers backbone to facing either of her inner thighs.

This movement is called external rotation because part of the baby is already outside the mother (it is also

called restitution). The rotation is necessary as the babys shoulders must fit around and under the mothers

pubic bone.

7. ExpulsionAlmost immediately after external rotation, the anterior (foremost) shoulder moves out from under the pubic

bone. The mothers perineum becomes distended by the posterior (second) shoulder, which is then also born.

The rest of the babys body is then born (expulsion), with an upward motion of the babys body assisted by

the care provider.

In conclusion

Note that at every stage of labour there is descent. To be specific, after the fetal head undergoes flexion, thereis descent; after internal rotation, there is descent; after extension, there is descent and so on. In the next

study session, we will describe the progress of a normal labour in more detail.

Documents

How to Perform Leopold