Leopold Maneuver is a physical examination done for pregnant women by doctors and midwives. It helps to identify the lie and the presentation of the baby in the womb.
And like any other physical examination, leopold maneuver also starts with an inspection.
This is the first step of all physical examinations in medicine. We see 5 things during the inspection, particularly in the leopold maneuver.
- Symmetry – it is natural if a pregnant mother’s womb is asymmetric. It is based on the baby’s position in the womb.
- Stria gravidarum – it is a stretch mark which is normal in pregnancy which increases as pregnancy advance.
- Linea nigra – is a stretch mark that finds in the midline position of the abdomen in a pregnant woman. it is also a normal finding in pregnant women.
- Inspect if the fetal movement is seen – sometimes fetal movement can be seen during abdominal examination in pregnant women. it is a perfectly normal situation.
- Previous C/s scar – C-section scars are usually found above the suprapubic area. Management wise, it will help the doctor to decide what kind of delivery is appropriate for the patient. If the mother has one lower uterine segment C/s, she can opt for what kind of delivery she needs. But if she has 2 lower uterine segment C/s or even one upper uterine C/s, it is absolute that she will deliver with C/s. However sometimes abdominal incision and uterine incision can be different so you should see her file to figure out what kind of c/s she had in the past.
Leopold Maneuver 1 – Fundal Palpation
This is the first step of the Leopold maneuver. And the main objective of this step is to estimate the Gestational age using fundal height. And to know what occupy fundus.
There are 2 ways to measure fundal height.
- Tape measurement
- Finger measurement
Tape measurement – you will first demarcate the fundus then measure from symphysis pubis up to umbilicus. Then estimate gestational age.
Finger measurement – the same applies here. you should demarcate the fundus and then measure. If the fundus is up to the umbilicus, it suggests the gestational age of 20 weeks. And if the fundus is at the symphysis pubis, it suggests 12 weeks. Then if the fundus is above the umbilicus, we add 2 weeks for every finger it accommodates. And if the fundus is below the umbilicus, we subtract 1 week from 20 weeks.
What Occupy Fundus?
The next step of Leopold one is to palpate what occupies the fundus. It can be the head of the baby or the buttock of the baby. And during palpation, we can differentiate those 2 if we know what features they have. Head is usually regular, ballotable, hard, and non-bulky. whereas buttock is nonregular, nonbillable, soft, and bulky.
Leopold Maneuver 2 – Lateral palpation
In this step of the Leopold maneuver, we can know the lie of the fetus and at which side the fetus back is. This is where the doctor checks the fetal heartbeat of the baby.
The lie is the position of the baby according to the long axis of the mother. It can be longitudinal or transverse. If the long axis of the baby parallels to the mother, that is a longitudinal lie. And if the long axis of the baby is perpendicular to the mother, that is a transverse lie.
Identify the Back of the Fetus
The back of the fetus usually feels like a board like a regular hard structure. It can be palpated either on the left or on the right side of the mother. Once you palpate that, you can find the heartbeat of the fetus at the back of the baby.
Leopold Maneuver 3 – Pelvic Palpation
This is where you appreciate the presentation, attitude, and descent of the fetus.
You will identify what the lower pole of the fetus is. It can be cephalic or breach. The normal one is cephalic. And during palpation, we can differentiate those 2 if we know what features they have. Head is usually regular, ballotable, hard, and non-bulky. whereas breech is nonregular, nonbillable, soft, and bulky.
Attitude is the relationship between head and trunk. This step is palpation of the cephalic prominence of the fetus. if you palpate the fetal cephalic prominence aside from the back, it means the baby head is extended. and if you palpate the fetal cephalic prominence opposite to the back, it means the baby head is flexed.
Decent (Rule of 5)
in this step, you will put your hand between the symphysis pubis and anterior shoulder of the baby. If you can put all you five fingers, it means the baby head is not engaged, it is floating,. if you can put 4 fingers, it is fixed. if we can put 2 fingers out of 5, we can say the baby head is engaged (at ischial spine).
Leopold Maneuver 4 – Pawlik’s grip
This step is where you cross-check the descent of the baby’s head. You will grip the fetal head, and try to move side to side. If it doesn’t move, it means the baby’s head is engaged. It can be painful to the mother so be sure if she is comfortable.
A Typical example of Leopold Maneuver
This is 38 weeks gravid uterus and funds is occupied by nonregular, nonbillable, soft, and bulky part of the fetus. The long axis of the baby is parallel to the mother and board like, regular and hard structure is palpated on the left side of the mother. the fetal heartbeat is 145. The pelvis is occupied by regular, ballotable, hard, and non-bulky parts of the fetus, and the cephalic prominence of the baby palpated opposite to the back of the fetus. The fetal head is engaged.
See the video below to understand the concept more.
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