06.03 Leopold Maneuvers

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In this lesson I will explain the use of leopold’s maneuver and how this is incorporated into practice.

So what is this maneuver and why do we do it? It is a palpation of the mother’s abdomen or uterus. It is done so we can feel the fetal position. Why would we need to know this? We need to know what the presenting part is. We need to make sure the fetus is head down. We need to know where the fetal back is because this is where we put the monitor to detect the fetal heart rate. So let me explain why because I know that seems weird. If a fetus is curled up in a fetal position then we can’t access the heart to put it on. Also the back is a large surface area so we can easily get the monitor against the fetal back.
Let’s look at the maneuvers so there are four different maneuvers. First is the fundal grip. If there is a head it will feel hard, round and moveable. If it is a bottom then it will feel harder and irregular. The next is Umbilical grip. You are feeling on the sides and should feel a smooth long back on one side. The other side should feel irregular bumps and lumps on the side which is going to indicate fingers, toes, and knees. The next is the first pelvic grip. This is done by facing the mother. And this will determine which part is the presenting part andis engaged. The second pelvic grip is done by facing the mother’s feet and will determine if it is flexion or extension of the baby’s head. Of course this grip only works if it is the head that is the presenting part.
Our management for this patient is really just to make sure she is laying back comfortable. This is a lot of pushing and maneuvering to assess the fetal position. It will be helpful to ensure the patient has an empty bladder as well because of all the manipulation. We are looking for the presenting part and determining the best location to assess heart tones.

Comfort and reproduction will be our nursing concepts. We need to keep the patient comfortable during this and has reproduced.

Let’s review the key points. The leopold’s maneuver is done to assess where the fetal back is for heart tones and to determine the presenting part. Do do this the fundal maneuver is first assessed. And this is done by pressing at the top of the uterus, the fundus. Next the umbilical grip and this is feeling the sides. The last two are pelvic grip. The first is facing the mother to feel in the pelvis at what the presenting part is. The next pelvic is done at the maternal head. This is done if the head is determined to be in the pelvis to find if it is flexed or extended. So what do we feel? If it is firm and moveable ball it is the head. If it is firm, irregular it is the fetal butt. If you feel small bumps these are fists and knees.

Make sure you check out the resources attached to this lesson. Find a friend and practice the maneuvers as well as reviewing what each part feels like. Now, go out and be your best selves today. And, as always, happy nursing.
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