Lesson Abdominal Assessment

Leopold’s Maneuver

https://www.youtube.com/watch?v=6y7XKFiBpfo

Leopold’s Maneuvers are a systematic method of observation and palpation to

determine fetal position, presentation, lie and attitude. The maneuvers are important
because they help determine the position and presentation of the fetus, which in
conjunction with correct assessment of the shape of the maternal pelvis can indicate
whether the delivery is going to be complicated, or whether a Cesarean section is
necessary.

Keen observation of abdomen should give data about:

1. Longest diameter in appearance (longest diameter (axis) is the length of the
fetus)
2. Location of apparent fetal movement (the location of the activity most likely
reflects the position of the feet)

PREPARATION
 1. CARDINAL RULE: instruct woman to empty bladder first. This will
promote comfort and allows for more productive palpation because
fetal contour will not be obscured by a distended bladder.
2. Place woman in dorsal recumbent position, supine knee flexed to
relax abdominal muscles. Place a small pillow under the head for
comfort.
3. Drape properly to maintain privacy.
4. Explain procedures to gain patient’s cooperation
5. Warm hands first by rubbing them together before placing them over
the woman’s
abdomen to aid comfort. Cold hands may stimulate uterine
contractions.
6. Use the palm for palpation, not fingers.
7. During the first three maneuvers, stand facing the patients. For
the last
maneuver, stand facing the patient’s feet

FIRST MANEUVER:

Fundal Grip: what fetal pole or part occupies the fundus?

 Palpation of the fundal area to determine which fetal part is in the
uterine fundus
 To determine the presenting part of presentation (part of the fetus
lying over the
inlet)

Procedures

1. Nurse stand at the side of the bed, facing the patient

2. Using both hands, feel for the fetal par lying in the fundus

Findings
The nurse-midwife should ascertain what is lying at the fundus by feeling the upper
abdomen (fundus) with tips of both hands. generally, she will find there is a mass,
which will either be the head or the buttocks (breech) of the fetus. The nurse-midwife
must decide which pole of the fetus; it is by observing three points:

 Relative consistency- the head is harder/firmer than the breech

 Shape- if the head, it will be round and hard, and the transverse
groove of the
neck may be felt. The breech has no groove and usually feels
more angular.
  Mobility- the head will move independently of the trunk; but the
breech
moves only in conjunction with the body.

If the nurse-midwife feels the head, the fetus is in breech presentation; if the
nurse-midwife
feels the buttocks, it means the fetus is in vertex presentation.

SECOND MANEUVER: Umbilical Grip: Which side is the fetal back?

To locate/identify the fetal back in relation to the right and left sides of the mother
To determine the fetal position (the relationship of the presenting part to one of the
quadrants of the mother’s pelvis)

Procedures
1. The nurse-midwife places the palmar surfaces of both hands on either side of
the abdomen
2. With left palm stationary on the left side of the abdomen to steady the
uterus, the right
palpates the right side of the uterus on a circular motion from top to lower
segment of the
uterus applying gentle but deep pressure to palpate the fetal outline and
small fetal parts
3. The nurse-midwife the reverses her hands

Findings
Small fetal parts (knee and elbows) feel nodular with numerous angular nodulations.
Fetal back feels smooth, hard, like a resistant surface

THIRD MANEUVER: Pawlik’s Grip: What fetal part lies above the pelvic inlet?

 Determine if the presenting part has entered the pelvis (engagement of

presenting
part)
 To find the head at the pelvis and to determine the mobility of the
presenting part

Procedures
1. The nurse-midwife stands at the side of the bed, facing the patient
2. It should be conducted by gently grasping the lower portion of the abdomen,
just above
the symphysis pubis, between the thumb and the two fingers of one hand
and then
pressing together slightly and make gentle movements from side to side

Findings
If the presenting part moves, round, ballotable and easily displaces it is not yet
engaged. If
 the presenting part not movable felts as relatively fixed, knoblike part, it is
engaged.
If it is firm, it must be the head. If soft, it could be breech

FOURTH MANEUVER: Pelvic Grip: Which side is the cephalic prominence?

Cephalic prominence is a part of the fetal head that prevents the deep descent
with one
hand
To determines the degree of fetal head flexion or extension
To determine the attitude or habitus (degree of flexion of the fetal body, head
and
extremities, or the relationship of fetal parts to each other)
To determine the fetal descent
Should only be done if fetus is in cephalic presentation. Information about the
infant’s
anteroposterior position may also be gained from this final maneuver

Procedures
1. The nurse-midwife faces the feet of the patient
2. Place one hand each on either side of the lower pole of the uterus
3. Palpate the fetal head by pressing downward about 2 inches above the
inguinal ligament
4. Use both hands

Findings
If descended deeply, only a small portion of the fetal head will be palpated.
If cephalic prominence or brow or the baby is on the same side of the small fetal
parts, the
head is flexed.
If the cephalic prominence is on the same side of the fetal back, the head is extended.

Things needed:

Tape measure
Blanket (to provide privacy)
Stethoscope
Clipboard (documentation

Leopold’s Maneuver Rationale

Preparation To relieve the patient’s anxiety and enhance
1. Explain the procedure and cooperation. To promote comfort and allows
instruct the mother to void to empty for more productive palpation because fetal
her bladder. contour will not be obscured by distended
bladder.
2. Wash your hands using warm To aid comfort and cold hands may
water. Drape properly. stimulate uterine contraction. To provide
privacy.

3. Position the client in a dorsal To relax abdominal muscles

recumbent position, supine with
knees slightly flexed.
Procedure
First maneuver: (Fundal grip)
1. Stand at the foot part of the To determine whether the fetal head or
client, facing her and place breech. When palpating, a head feels firmer
hands above the abdomen just than a breech. A head is round and hard;
below the xyphoid process. the breech is less well defined. A head
2. Gently move your hands moves independently of the body; the breech
downward and Page33 palpate moves only in conjunction with the body.
the superior surface of the
fundus

Second maneuver: (Umbilical grip)

1. Face the client, hold the left-hand To determine the location of the fetal back.
stationary of the uterus while you One hand will feel a smooth, hard, resistant
palpate with the right hand on the surface (the back), while on the opposite
opposite side of the uterus from top side, a number of angular nodulations (the
to bottom. Repeat palpation using knees and elbows of the fetus) will be felt.
the opposite side.

Third maneuver: (Pawlik’s grip)

1. Gently grasp the lower portion of To determine if the presenting part has
the abdomen just above the entered the pelvis (engagement of presenting
symphysis pubis between the part)
thumb and fingers and try to
press the thumb and fingers
together.

2. Determine any movement and If the presenting part moves, round,

whether the part feels firm or ballotable and easily displaces it is not yet
soft. engaged. If the presenting part not movable
felts as relatively fixed, knoblike part, it is
engaged.

If it is firm, it must be the head. If soft, it

could be breech.
Fourth maneuver: (Pelvic grip)

1. Place fingers on both sides of the To determines the degree of fetal head
uterus approximately 2 inches flexion or extension.
about the inguinal pressing
downwards and inward in the
direction of the birth canal.

2. Allow the fingers to be carried To determine the attitude or habitus (degree

downward to determine the fetal of flexion of the fetal body, head and
attitude and degree of fetal extremities, or the relationship of fetal parts
extension into the pelvis. to each other).

To determine the fetal descent