- Leopold's maneuvers
In
obstetrics , Leopold's Maneuvers are a common and systematic way to determine the position of afetus inside the woman'suterus .The
maneuver s consist of four distinct actions, each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and presentation of thefetus , which in conjunction with correctassessment of the shape of the maternalpelvis can indicate whether the delivery is going to be complicated, or whether aCesarean section is necessary.The examiner's skill and practice in performing the maneuvers are the primary factor in whether the fetal lie is correctly ascertained, and so the maneuvers are not truly
diagnostic . Actual position can only be determined byultrasound performed by a competenttechnician orprofessional .Performing the maneuvers
Leopold's Maneuvers are difficult to perform on obese women and women who have
hydramnios . Thepalpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, thehealth care provider should first ensure that the woman has recently emptied her bladder. If she has not, she may need to have a straight urinarycatheter inserted to empty it if she is unable tomicturate herself. The woman should lay on her back with hershoulder s raised slightly on a pillow and herknee s drawn up a little. Herabdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior topalpation .First maneuver
While facing the woman,
palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. Thefetal head is hard, firm, round, and moves independently of the trunk while thebuttocks feels softer, is symmetric, and has small bony processes; unlike thehead , it moves with the trunk.econd maneuver
After the upper
abdomen has been palpated and the form that is found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but also deep pressure using the palms of his or herhand s. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman'suterus . This is then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen.Third maneuver: Pawlick's Grip
In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. The individual performing the maneuver first grasps the lower portion of the abdomen just above the
symphysis pubis with thethumb andfinger s of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneauver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth.Fourth maneuver
The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus'
brow . The fingers of both hands are moved gently down the sides of theuterus toward the pubis. The side where there is the resistance to the descent of the fingers toward the pubis is greatest is where thebrow is located. If the head of the fetus is well flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, theocciput is instead felt and is located on the same side as the back .Cautions
Leopold's maneuvers are intended to be performed by health care professionals, as they have received training and instruction in how to perform them. That said, as long as care is taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at
home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as suchultrasound is required to conclusively determine fetal lie.References
* [http://www.prenhall.com/olds Maternal-Newborn Nursing & Women's Health Care, 7th Edition]
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