obstetrics Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgi ...

, Leopold maneuvers are a common and systematic way to determine the position of a

fetus A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal deve ...

inside the woman's

uterus The uterus (from Latin ''uterus'', plural ''uteri'') or womb () is the organ in the reproductive system of most female mammals, including humans that accommodates the embryonic and fetal development of one or more embryos until birth. The uter ...

. They are named after the gynecologist

Christian Gerhard Leopold Christian Gerhard Leopold (24 February 1846 – 12 September 1911) was a German gynecologist born in Meerane, Saxony. In 1870 he earned his medical doctorate from the University of Leipzig, where he studied under Carl Siegmund Franz Credé (1819- ...

. They are also used to estimate term fetal weight. The maneuvers 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 lie of the

, which in conjunction with correct

assessment Assessment may refer to: Healthcare *Health assessment, identifies needs of the patient and how those needs will be addressed *Nursing assessment, gathering information about a patient's physiological, psychological, sociological, and spiritual s ...

of the shape of the

maternal ] A mother is the female parent of a child. A woman may be considered a mother by virtue of having given birth, by raising a child who may or may not be her biological offspring, or by supplying her ovum for fertilisation in the case of gestat ...

human pelvis, pelvis can indicate whether the delivery is going to be complicated, or whether a

caesarean section Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen, often performed because vaginal delivery would put the baby or mo ...

is necessary. The examiner's skill and practice in performing the maneuvers are the primary factor in whether the fetal lie is correctly ascertained. Alternately, position can be determined by

ultrasound Ultrasound is sound waves with frequency, frequencies higher than the upper audible limit of human hearing range, hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hea ...

performed by a

sonographer A sonographer is an allied healthcare professional who specializes in the use of ultrasonic imaging devices to produce diagnostic images, scans, videos or three-dimensional volumes of anatomy and diagnostic data. The requirements for clinical pr ...

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

Performing the maneuvers

Leopold maneuvers are difficult to perform on

obese Obesity is a medical condition, sometimes considered a disease, in which excess body fat has accumulated to such an extent that it may negatively affect health. People are classified as obese when their body mass index (BMI)—a person's we ...

women A woman is an adult female human. Prior to adulthood, a female human is referred to as a girl (a female child or Adolescence, adolescent). The plural ''women'' is sometimes used in certain phrases such as "women's rights" to denote female hum ...

and women who have

polyhydramnios Polyhydramnios is a medical condition describing an excess of amniotic fluid in the amniotic sac. It is seen in about 1% of pregnancies. It is typically diagnosed when the amniotic fluid index (AFI) is greater than 24 cm. There are two clin ...

. The

palpation Palpation is the process of using one's hands to check the body, especially while perceiving/diagnosing a disease or illness. Usually performed by a health care practitioner, it is the process of feeling an object in or on the body to determine ...

can sometimes be

uncomfortable Comfort (or being comfortable'')'' is a sense of physical or psychological ease, often characterized as a lack of hardship. Persons who are lacking in comfort are uncomfortable, or experiencing discomfort. A degree of psychological comfort c ...

for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the

health care provider A health care provider is an individual health professional or a health facility organization licensed to provide health care diagnosis and treatment services including medication, surgery and medical devices. Health care providers often receive ...

should first ensure that the woman has recently emptied her

bladder The urinary bladder, or simply bladder, is a hollow organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In humans the bladder is a distensible organ that sits on the pelvic floor. Urine enters ...

. If she has not, she may need to have a straight urinary

catheter In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Cath ...

inserted to empty it if she is unable to

micturate Urination, also known as micturition, is the release of urine from the urinary bladder through the urethra to the outside of the body. It is the urinary system's form of excretion. It is also known medically as micturition, voiding, uresis, ...

herself. The woman should lie on her back with her

shoulder The human shoulder is made up of three bones: the clavicle (collarbone), the scapula (shoulder blade), and the humerus (upper arm bone) as well as associated muscles, ligaments and tendons. The articulations between the bones of the shoulder mak ...

s raised slightly on a pillow and her

knee In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia (tibiofemoral joint), and one between the femur and patella (patellofemoral joint). It is the largest joint in the hu ...

s drawn up a little. Her

abdomen The abdomen (colloquially called the belly, tummy, midriff, tucky or stomach) is the part of the body between the thorax (chest) and pelvis, in humans and in other vertebrates. The abdomen is the front part of the abdominal segment of the torso. ...

should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation.

First maneuver: fundal grip

While facing the woman, palpate the woman's upper abdomen with both hands. An obstetrician can often determine the size, consistency, shape, and mobility of the form that is felt. The

fetal A fetus or foetus (; plural fetuses, feti, foetuses, or foeti) is the unborn offspring that develops from an animal embryo. Following embryonic development the fetal stage of development takes place. In human prenatal development, fetal develo ...

head is hard, round, and moves independently of the trunk while the

buttocks The buttocks (singular: buttock) are two rounded portions of the exterior anatomy of most mammals, located on the posterior of the pelvic region. In humans, the buttocks are located between the lower back and the perineum. They are composed ...

feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the

head A head is the part of an organism which usually includes the ears, brain, forehead, cheeks, chin, eyes, nose, and mouth, each of which aid in various sensory functions such as sight, hearing, smell, and taste. Some very simple animals may ...

, they move with the trunk.

Second maneuver: lateral grip

After the upper

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 palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's

. 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: second pelvic grip or Pawlik'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

pubic symphysis The pubic symphysis is a secondary cartilaginous joint between the left and right superior rami of the pubis of the hip bones. It is in front of and below the urinary bladder. In males, the suspensory ligament of the penis attaches to the pubic ...

with the thumb and fingers of the right hand. This maneuver should yield the opposite information and validate the findings of the first maneuver. If the woman enters

labor Labour or labor may refer to: * Childbirth, the delivery of a baby * Labour (human activity), or work ** Manual labour, physical work ** Wage labour, a socioeconomic relationship between a worker and an employer ** Organized labour and the labour ...

, this is the part which will most likely come first in a

vaginal birth A vaginal delivery is the birth of offspring in mammals (babies in humans) through the vagina (also called the "birth canal"). It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with lower m ...

. If it is the head and is not actively engaged in the birthing process, it may be gently pushed back and forth.

Fourth maneuver: Leopold's first pelvic grip

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 the

toward the pubis. The side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal

back The human back, also called the dorsum, is the large posterior area of the human body, rising from the top of the buttocks to the back of the neck. It is the surface of the body opposite from the chest and the abdomen. The vertebral column run ...

. If the fetal head is extended though, the

occiput The occipital bone () is a cranial dermal bone and the main bone of the occiput (back and lower part of the skull). It is trapezoidal in shape and curved on itself like a shallow dish. The occipital bone overlies the occipital lobes of the cereb ...

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 A health professional, healthcare professional, or healthcare worker (sometimes abbreviated HCW) is a provider of health care treatment and advice based on formal training and experience. The field includes those who work as a nurse, physician (suc ...

, as they have received the training and instruction in how to perform them. If performed at home as an informational exercise, the examiner should take care to not roughly or excessively disturb the fetus. It is important to note that all findings are not truly

diagnostic Diagnosis is the identification of the nature and cause of a certain phenomenon. Diagnosis is used in many different disciplines, with variations in the use of logic, analytics, and experience, to determine " cause and effect". In systems engine ...

, and as such

may be required to conclusively determine the fetal position.

References

External links

Leopold's Maneuver Demo Video
{{Obstetrical procedures Tests during pregnancy