2. • The Leopold maneuvers are used to palpate the
gravid uterus systematically. This method of
abdominal palpation is of low cost, easy to perform,
and non-invasive. It is used to determine the
position, presentation, and engagement of the fetus
in utero.
3. • The Leopold maneuvers, named after the German
obstetrician and gynecologist Christian Gerhard Leopold
(1846–1911), are part of the physical examination of
pregnant women.
• Four classical maneuvers are used to palpate the gravid
uterus systematically. This method of abdominal palpation
is of low cost, easy to perform, and non-invasive. It is used
to determine the position, presentation, and engagement of
the fetus in utero.
• The aim of Leopold maneuvers is to determine the fetal
presentation and position by systematically palpating the
gravid abdomen.
4. The initial steps are described below
:
• Wash hands
• Explain the steps of the examination to the patient as this reduces anxiety
and enhances cooperation
• Obtain consent
• The patient should be advised to void as an empty bladder promotes
comfort and allows for more productive examination, and the distended
bladder can obscure fetal contour
• Provision of privacy
• Prepare the equipment, such as measuring tape, Pinard stethoscope or
Doppler transducer, and ultrasound gel
• Position the patient supine with the head of the bed raised to 15 degrees,
and a small pillow or rolled towel placed on her right side
• Adequate exposure of the gravid abdomen from the xiphisternum to the
pubic symphysis
• Inspect the gravid abdomen
5. Leopold Maneuvers:
• Leopold maneuvers are begun in late pregnancy to determine which
way the baby is presenting in the uterus and consists of four parts:
• 1. First maneuver answers the question: “ What fetal part occupies the
fundus?”
• 2.Second maneuver answers the question : “ On what side is the fetal
back? “
• 3.Third maneuver answers the question : “ What fetal part lies over
the pelvic inlet?”
• 4. Fourth maneuver answers the question: “ On which side is the
cephalic prominence? “
6. Four aspects of the fetus are described from the Leopold
maneuvers:
• -Lie
• -Presentation
• -Position
• -Attitude
7.
8. Lie -describes the relation of the long axis of the
fetus to that of the mother. A longitudinal (99% of
term or near-term birth) lie can be vertex (head first)
or breech (buttocks first ). The lie may be transverse
or oblique
9. Presentation / Presenting part - describes the
position of the fetus that is foremost within the birth
canal. It is normally determined by palpating through the
cervix on vaginal examination
• -If the lie is longitudinal, the presentation is either the
head (cephalic), buttocks (breech), brow or face. The
most common type of presentation is the vertex
presentation in which the posterior fontanel is the
presenting part
• -If the lie is transverse , the shoulder , back or abdomen
may be the presenting part
10. Position - refers to the relation of the presenting part to the
right (R) or left (L) side of the birth canal and its direction
anteriorly (a) , transversely (T), or posteriorly (P).
• -The top of the fetal skull is composed of five bones : 1) two
frontal , 2) tow parietal , 3) one occipital. The anterior fontanel
lies where the two frontal and two parietal meet, and the
posterior fontanel lies where the two parietal meet the occipital
bone
• -For a cephalic presentation , the occiput is used as the reference
point to determine the position
11. For a cephalic presentation , the occiput is used as the reference point to determine
the position
• -Occiput anterior (OA)
• -Occiput posterior (OP)
• -Left occiput anterior (LOA)
• -Left occiput posterior (LOP)
• -Left occiput transverse (LOT)
• -Right occiput anterior (ROA)
• -Right occiput posterior (ROP)
• -Right occiput transverse (ROT)
• -The chin is used as the reference point for face presentation. The sacrum is used as
the reference point for breech presentation
12. Attitude and posture -In the later months of pregnancy, the fetus assumes a
characteristic posture (“attitude /habitus”), which typically describes the
position of the arms, legs, spine, neck and face
13. What is fundal height?
• Fundal height is the distance between your pubic bone
and the top of your uterus during pregnancy. Measuring
fundal height helps healthcare providers assess if the fetus
is developing correctly. It also can help determine
gestational age (term to describe how far along the
pregnancy is) and the fetus's position in your uterus. It's
measured in centimeters with measuring tape. After about
20 weeks of pregnancy, your fundal height in centimeters
should be close to the fetus's gestational age. For example,
if you are 24 weeks pregnant, your fundal height should
be around 24 centimeters.
14. Your healthcare provider measures fundal height at each prenatal
appointment beginning at about 20 weeks in pregnancy. This is the
approximate time when fundal height and gestational age begin
matching each other.
15. • The index of symphysis-fundal height and abdominal
circumference (ISFHAC) combines SFH and AC,
which are used to evaluate foetal birth weight, and
this index has great potential for use in predicting
macrosomia in normal pregnancies (NPs) and GDM
pregnancies.
