Leopold's Maneuver - Panpacific University PDF

LEOPOLD’S MANEUVER Leopold’s Maneuver – An abdominal observation and palpation using the (4) maneuvers of Leopold’s to provide a systematic examination. To determine the position and presentation of the fetus. PURPOSE: To identify the presentation, position, degree of descent, and attit...

LEOPOLD’S MANEUVER Leopold’s Maneuver – An abdominal observation and palpation using the (4) maneuvers of Leopold’s to provide a systematic examination. To determine the position and presentation of the fetus. PURPOSE: To identify the presentation, position, degree of descent, and attitude of the fetus To identify the point of maximum intensity of the fetal heart tone in relation to the women’s abdomen To determine number of fetus inside the womb Primary tool: Palpation Technique Performed: Preferably after 32 weeks of Leopolds Maneuver P resentation A ttitude L ie P osition A ctual number of fetuses Fetal Presentation - Part of fetus lying in pelvic inlet or cervical os Cephalic/Vertex Face/brow Transverse/Shoulder Complete breech Incomplete/footling breech Frank breech  Fetal Attitude - Is the posture of the fetus Good attitude – Flexion Poor attitude – Extension Fetal Lie - Relationship of fetal spine and maternal spine Longitudinal lie – Vertex/Breech presentation Transverse lie - Shoulder presentation  Oblique lie Fetal Lie - Relationship of fetal spine and maternal spine Longitudinal lie – Vertex/Breech presentation Transverse lie - Shoulder presentation  Oblique lie Fetal Position -relationship of the denominator Indicated by threeor landmark letters abbreviation of the presenting part 1. Identify which sideto thethe mother’s presenting part is facingpelvis the pelvis R (right) L (left) 2. Identify the landmark that is presenting O – occiput or head S – sacrum or buttocks Sc – scapula or shoulder M – mentum or chin 3. Identify the direction the presenting part is facing in the pelvis A – anterior P – posterior T – transverse    4 Maneuvers LM1 – Fundal grip – upper part of abdomen (fundus) LM2 – Umbilical grip – lateral sides of abdomen LM3 – Pawlicks grip – lower portion of abdomen (just above symphysis pubis) LM4 – Pelvic grip – palpate down the  CHECKLIST Procedure: 1. Identify the client and explain the procedure. 2. Ask the client to empty or void her bladder. 3. Wash hands. 4. Ask client to lie on her back with knees slightly flexed. 5. Drape client and expose the abdomen from the level of the xyphoid process down to the symphysis pubis 6. Warm hands before touching the abdomen of client. 7. Stand facing the head part of the client. 8. Palpate the upper abdomen by placing both palms on either side of the abdomen. 9. Identify correctly the fetal parts. Findings: The nurse-midwife should ascertain what is lying at the fundus by feeling the upper abdomen (fundus) with tips of both hands. 1. You will find there is a mass, which will either be the head or the buttocks (breech) of the fetus. The fetal head is hard, firm, round, and moves independently of the body. (Breech) The buttocks is soft mass, symmetric, and has small bony prominences; it moves with the trunk. (Cephalic)  10. Put both hands on either side of the abdomen, applying gentle but deep pressure 11. Hold one side of the abdomen steady, gradually palpate opposite side from top to the lower segment of the abdomen to feel the fetal outline in a slightly circular motion. 12. Repeat the same procedure on the opposite side. Findings: 1.Small fetal parts (knees and elbows) feel nodular with numerous angular nodulations, small irregularities, and protrusions. 2.Fetal back firm, smooth, hard, like a resistant surface. 14. With the right hand, gently grasp the lower abdomen, above the symphysis pubis, press in lightly using thumb and finger and make gentle movements from side to side 15. Identify correctly the presenting part and engagement. Findings: 1.If the presenting part moves, round, and easily displaced it is not yet engaged. 2.If the presenting part is not movable feels as relatively fixed, knoblike part, it is engaged. 3.If it is firm, it must be the head. If the soft, it could be breech. 16. Face the client’s foot part, palm on the sides of the abdomen, just above the inguinal ligament, grasping snugly the lower abdomen and the outstretched thumbs meeting at the umbilical level. 17. Identify correctly the degree of flexion and position of the presenting part. 18. Make no unnecessary exposure of client’s body. 19. Reposition the client 20. Document and record fetal findings. Documentation of observation made; the fetal findings, presentation, position, attitude. THANK YOU