What are Leopold's Maneuvers and How Are They Performed?
Leopold’s maneuvers are a set of important techniques that are performed to find out if the baby’s head is in the birth canal in late pregnancy. Therefore, they contribute to the planning of a safe and uncomplicated delivery.
Do you know how to perform them? Here, we’ll detail everything you need to know to arrive at the moment of giving birth with more peace of mind. Take note!
What are they and why are they performed?
Leopold’s maneuvers are a non-invasive method for estimating the size of the baby in the uterus and its position during the third trimester. Specifically, they’re a set of four maneuvers, whose objective is to determine the location and fetal presentation by palpating the gravid abdomen.
They focus on determining the presentation, which is the part of the baby’s body that’s at the entrance of the pelvis. In other words, these maneuvers help us to know if the head, buttocks, or shoulders are the first to come out during labor.
The most common presentation is cephalic (or head first) and the others are considered atypical. The latter are those in which the vertex of the head doesn’t relate to the mother’s pelvis. These atypical positions can be:
- Transverse position
- Breech presentation
- Oblique position
It’s important to detect abnormal presentations early before the onset of labor in order to reduce maternal and fetal risks related to complications of vaginal delivery or cesarean section. In fact, the detection of abnormal positions in the last trimester of pregnancy contributes to the implementation of appropriate care measures.
How are Leopold’s maneuvers performed?
Each maneuver requires a different technique, and we’ll tell you about them below.
The examiner places both hands in the upper quadrant of the abdomen to palpate the fetal head, chest, and lower part of the fetus to determine the approximate size and position.
The fundal grip maneuver evaluates the fundus to determine its height and which fetal end (cephalic or breech) is occupied by this structure. It also aims to determine the fetal presentation and to estimate if the size is in accordance with gestational age.
Deep pressure is applied with the palm of one hand while the other hand is used to palpate the uterus. This helps to locate the location of the small parts of the baby and the back.
Second pelvic grip or Pawlik’s grip
The examiner uses the thumb, index, and middle fingers (C-shaped hand) to feel which part of the fetus is in the lower quadrant of the abdomen. In this way, it’s possible to check if it’s in the correct presentation.
Leopold’s first pelvic grip
The examiner faces the maternal pelvis and places the hands on the abdomen and slides them over the uterine side in the direction of the pubis. This maneuver serves to determine the degree of wedging in the birth canal.
What are the advantages of performing these maneuvers?
Performing these maneuvers involves a number of benefits and advantages that you’ll learn about below.
1. Accurate assessment of the fetal position
Leopold’s maneuvers provide a systematic and detailed assessment of the fetus in utero, allowing the healthcare provider to obtain crucial information about its position and presentation.
2. Orientation during labor
These maneuvers help determine the position of the fetus prior to delivery, allowing medical personnel to anticipate possible complications and prepare adequately.
3. Reducing unnecessary interventions
By obtaining accurate information about the position of the fetus, Leopold’s maneuvers can help avoid unnecessary medical interventions, such as emergency cesarean sections, and promote safe vaginal delivery.
4. Monitoring fetal well-being
These maneuvers also help assess the well-being of the fetus, such as the location of the heartbeat, which provides vital information about the baby’s health during pregnancy.
Is it true that they can be used to estimate the baby’s weight?
In turn, Leopold’s maneuvers can be very useful in estimating the baby’s potential weight. This also helps with birth planning, whether vaginal or cesarean delivery.
However, a study published in the journal BMJ suggests that palpation of the gravid abdomen fails to detect large numbers of fetuses with atypical presentation.
Nevertheless, Leopold’s maneuvers can contribute to the visualization and perception of the babies by the mothers. Thus, according to a study conducted by the Japan Journal of Nursing Science, abdominal palpation can develop the maternal-fetal relationship, which plays an important role in the psychological, social, and cognitive development of the child.
Are there any risks or contraindications?
In general, Leopold’s maneuvers aren’t recommended before 36 weeks because they’re not very accurate at this stage. They’re also not recommended for women who are obstructed or have polyhydramnios.
Leopold’s maneuvers should only be performed by trained medical professionals who’ve undergone the appropriate training to perform them safely. In addition, it’s important that healthcare professionals continue to perform ultrasounds prior to delivery to corroborate the baby’s position.
Considerations to keep in mind
When performing Leopold’s maneuvers, it’s critical to have trained personnel, create an appropriate environment, and use the results in conjunction with other prenatal assessment methods. By following these recommendations, an accurate and safe assessment of the baby’s well-being in utero can be assured, providing peace of mind to both the mother and the medical team.It might interest you...
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- Celik, M., & Ergin, A. (2020). The effect on pregnant women’s prenatal attachment of a nursing practice using the first and second Leopold’s maneuvers. Japanese Journal of Nursing Science, 17(2), e12297. doi: 10.1111/jjns.12297. PMID: 31762185.
- McCowan, L. M., Figueras, F., & Anderson, N. H. (2018). Evidence-based national guidelines for the management of suspected fetal growth restriction: comparison, consensus, and controversy. American Journal of Obstetrics & Gynecology, 218(2S), S855-S868. doi: 10.1016/j.ajog.2017.12.004. PMID: 29422214.
- Nassar, N., Roberts, C. L., Cameron, C. A., & Olive, E. C. (2006). Diagnostic accuracy of clinical examination for detection of non-cephalic presentation in late pregnancy: cross sectional analytic study. BMJ, 333(7568), 578-580. doi: 10.1136/bmj.38919.681563.4F. PMID: 16891327; PMCID: PMC1570002.