This document describes the Fifth Leopold or Zangemeister maneuver, which is used to determine if a woman's pelvis is contracted during labor. The maneuver involves placing one hand on the woman's pubic bone and the other on the baby's head. There are three potential findings: 1) the head is lower than the pubic bone, indicating no pelvic contraction, 2) the head and pubic bone are at the same level, indicating moderate pelvic contraction, or 3) the head is higher than the pubic bone, indicating significant or extreme pelvic contraction. Significant pelvic contraction means the baby's head is unlikely to fit through the pelvis during a vaginal delivery.

1. FIFTH LEOPOLD
OR
ZANGEMEISTER MANEUVER Dr. Sujnanendra Mishra

2. FIFTH LEOPOLD OR
ZANGEMEISTER MANEUVERTo determine whether the head protrudes anteriorly. Standing at the side of the
supine woman,
One hand is placed flat on the symphysis pubis (symphysis hand), the other (head
hand) on the head above the symphysis pubis.
There are three possibilities:
Head hand is one finger-width lower than the symphysis pubis, no CPD.
Both hands are at the same level, moderate CPD. SVD probable if contractions are good
and head presentation favorable. Decision possible only after ROM. However, SVD is not to
be expected if despite good contractions this finding does not alter after ROM. Head hand
is higher than symphysis hand;
Head is higher than the symphysis pubis. Significant To Extreme CPD The head is not
likely To Enter the pelvis. This is also the Case if the head is only Slightly Higher Than the
symphysis pubis.
The head is higher than the pelvis if the pelvis is contracted, the head too high,
malpresenting or malposition or its entry is obstructed, e.g., due to hydrocephalus,
prolapsed arm, pelvic, ovarian or uterine tumor.
Combined external-vaginal maneuver. The left index finger examines vaginally, the right
hand goes to the head, externally. When the external hand moves the head back and forth,

3. Fig. 1. Symphysis pubis is higher than the head engaged in the PI, the head fits the pelvis, no CPD.
Fig. 2. Head and symphysis pubis are at the same level, the head shears: moderate CPD. Good
contractions and favorable presentation make SVD possible to likely.
Fig. 3. The head is higher than the symphysis pubis: significant to extreme CPD. Unfavorable
prognosis.
Joachim W. Dudenhausen
Practical Obstetrics. Ch.8 Pathological
Labor p296
Fig. 3Fig. 2Fig. 1