LEOPOLD’S MANEUVER.2.pptx

8/10/2019 LEOPOLD’S MANEUVER.2.pptx

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LEOPOLD’S MANEUVER

Leopold's maneuvers ( Leopold Handgriffe )Christian Gerhard Leopoldis preferably performed after 24 weeks

gestation when fetal outline can be alreadypalpated.are a common and systematic way to

determine the position of a fetus inside thewoman's uterus.



The maneuvers consist of four distinct actionsto determine the position of the fetus.

important because they help determine theposition and presentation of the fetusin conjunction with correct assessment of the

shape of the maternal pelvis can indicatewhether the delivery is going to becomplicated, or whether a Cesarean section isnecessary.

Actual position can only be determined byultrasound performed by a competenttechnician or professional.



PREPARATION:

Instruct woman to empty her bladder first.Place woman in dorsal recumbent position,supine with knees flexed to

relax abdominal muscles. Place a smallpillow under the head for comfort.Drape properly to maintain privacy.Explain procedure to the patient.

Warms hands by rubbing together. (Coldhands can stimulate uterine contractions).Use the palm for palpation not the fingers.



PR OCEDU R ES:



FIRST MANUEVER: Fun dal Grip

While facing thewoman, palpate thewoman's upperabdomen with bothhands.Palpate the uterus byfeeling the upperabdomen with bothhands.



WHAT IS T HE PURPOSE?

To determine fetal part lying in thefundus.To determine presentation.



FINDINGS?

Head is more firm, hard and round thatmoves independently of the body.

buttocks feels softer, is symmetric, andhas small bony processes; unlike thehead, it moves with the trunk.

Breech is less well defined that moves onlyin conjunction with the body.





SECOND MANEUVER: Umbilical Grip

1. Locate the back of the fetus in relation tothe right and left side of the mother.2. Still facing the client, place the palmar surfacesof the both hands on either side of the abdomenand apply gentle but deep pressure.3. If the hand of one side of the abdomen remainsstill to steady the uterus, a slightly circular motion

with the flat surface of the fingers on the otherhand can gradually palpate the opposite side fromthe top to the lower segment of the uterus to feelthe fetal outline.



4. To palpate the other side,the functions of the hands arereversed.5. On the fetal back, smooth, hardresistant place will be felt; sidewith fetal extremities will feelnodular, reflecting portions of fetalextremities.




To identify location of fetal back.

To determine position



FINDINGS?

Fetal back is firm, smooth, hard, and resistantsurfaceThe fetal back, once determined, should

connect with the form found in the upperabdomen and also a mass in the maternalinlet, lower abdomen.Knees and elbows of fetus feel with anumber of angular nodulationfetal extremities (arms, legs, etc.) shouldfeel like small irregularities and protrusions.





THIRD MANEUVER:Pawlick’s Grip

1. Gently grasp the lower portion of the abdomen, just above the symphysis pubis between the thumband the fingers of one hand.

This maneuver should yield the oppositeinformation and validate the findings of the firstmaneauver.If the woman enters labor, this is the part which willmost likely come first in a vaginal birth. If it is thehead and is not actively engaged in the birthingprocess, it may be gently pushed back and forth.

2.Then press together.




To determine engagement of presentingpart.to determine what fetal part is lying abovethe inlet, or lower abdomen.FINDINGS? The presenting part is not engaged if it isnot movable.It is not yet engaged if it is still movable.





FOURT H MANEUVER: Pelvic Grip

1. Face the client·s feet.2. The tips of the first 3 fingers areplaced on bothsides of the midlineabout 2 inches above the Poupart·sligament.3. Pressure is now made downward

and the direction of the birth canal,the movable skin of the abdomenbeing carried downward along withthe fingers.



4. The fingers of one hand meet noobstruction and be carried down wardwell under Poupart·s ligament.These

fingers glide over the nape of the baby·sneck.5. The other hand however usuallymeets an obstruction an inch or

so above the Pouparts·s ligament. Thisis the brow of the baby and is usuallyspoken of as the cephalic prominence.



W hat is the purpose?To determine the fetal attitude and thedegree of fetal extension into the pelvis.It should be done only if the fetus is incephalic presentation



If the head of the fetus is well flexed, itshould be on the opposite side from thefetal back.

If the fetal head is extended though, theocciput is instead felt and is located onthe same side as the back .

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LEOPOLD’S MANEUVER.2.pptx