Leopold’s Maneuvers – Part I

Learn about Leopold’s Maneuvers, a technique used to evaluate the pregnancy of women during gestation.

The Leopold’s Maneuvers are part of the physical examination of pregnant women and are used to determine fundal height, position, presentation and degree of fetal fetal attachment. This method of abdominal palpation is inexpensive, easy to perform and noninvasive.

It should be performed from 20 to 22 weeks of gestation, but better results will be obtained if done specifically at 32 weeks of gestation. Named after the German obstetrician and gynecologist Christian Gerhard Leopold (1846-1911).

What do the Leopold’s maneuvers evaluate?

• First maneuver: Identifies which fetal pole is occupying the uterine fundus, either the cephalic pole or the pelvic pole “Defines which pole is in the uterine fundus”.
• Second Maneuver: position of the fetus (left or right) and the situation (longitudinal or transverse) fetal “Define on which maternal side (right or left) is the back of the product.”
• Third Maneuver: identify the height of the presentation (free, flared and embedded), and corroborate the presentation.  “Define whether the presentation is boxed or not.”
• Fourth Maneuver: Identify the presentation and corroborate the height of the presentation (free, flared and boxed). “Define what type of presentation is flared to the upper pelvic brim.”

How are the Leopold’s maneuvers performed?

Preparation:

The goal of the Leopold maneuvers is to determine fetal presentation and position by systematically palpating the gravid abdomen. The initial steps are described below:

1. Wash hands.
2. Explain the steps of the exam to the patient, as this reduces anxiety and improves cooperation.
3. Obtain consent
4. The patient should be encouraged to urinate, as an empty bladder promotes comfort and allows for a more productive exam, and a distended bladder may be confused with fetal contour.
5. Provision of privacy
6. Prepare equipment, such as tape measure, Pinard stethoscope or Doppler transducer, and ultrasound gel.
7. Place the patient in the supine position with the head of the bed elevated to 15 degrees and a small pillow or rolled towel placed on the patient’s left side.
8. Adequate exposure of the gravid abdomen from the xiphisternum (xiphoid appendix of the sternum) to the pubic symphysis.
9. Inspect the gravid abdomen