Nurses use the Leopold Maneuvers when caring for their pregnant patients. Nurses must remember to perform 4 specific actions as a part of these methods. The skill of the individual performing the maneuvers is critical to determining if the fetus is in the correct position so it is very important that nurses learn to execute the Leopold Maneuvers correctly.
What are Leopold Maneuvers?
The Leopold Maneuvers are used to help nurses determine fetus’ presentation and position. The maneuvers have 4 specific actions that nurses must perform. Nurses use this process along with the assessment of the maternal pelvis’ shape to determine if complications will occur during the delivery and if the patient will require a Cesarean section.
Steps on How to Perform Leopold Maneuvers
Maneuver One: Fundal Grip
- Using both hands and facing the patient, palpate the upper abdomen. The nurse should use this method to determine the shape, size, mobility, and consistence of what he or she feels. The nurse should feel that the limbs and shoulders contain little bone processes that move with the fetus’ trunk; the head is firm, hard, round and moves separately from the trunk; and the buttocks is symmetric and feels soft.
Maneuver Two: Umbilical Grip
2. After the nurse identifies the form and palpates the upper abdomen, the location of the fetus’ back must be identified.
3. While still facing the patient, the nurse should apply deep pressure with the palm of his or her hands to palpate the abdomen gently. Perform this maneuver by placing the right hand on one side of the patient’s abdomen while using the left hand to explore the woman’s uterus on the right side. Repeat this step on the opposite side using the opposite hand.
4. The nurse should observe that the fetal back is smooth and firm. The extremities of the fetus should feel like protrusions and small irregularities. The back should connect with the form felt in the lower (maternal inlet) and upper abdomen.
Maneuver Three: Pawlick’s Grip
5. During this step of the process, the nurses must identify the part of the fetus that is above the inlet. The nurse must use the fingers and thumb on the right hand to grasp the lower abdomen area located above the pubic symphysis. The findings should validate what is determined in the first maneuver.
6. The two- hand approach is an alternative that is more comfortable for the patient. Nurses can perform this approach by positioning the fingers of both hands in a lateral position on one side of the presented part.
Maneuver Four: Pelvic Grip
7. This step should be done while facing the patient’s feet. The process involves locating the fetus’ brow. The nurse should gently move the fingers on both hands toward the pubis by sliding the hands over the sides of the patient’s uterus, and the side where the greatest resistance to the descending fingers is the location of the brow. A well-flexed fetal head is located on the opposite side of the fetal back. If the head is extended, the back of the head is felt on the side that the back is located. A head that cannot be felt has likely descended.
Video on How to Perform Leopold Maneuvers
Tips for Performing Leopold Maneuvers
- Instruct the female to empty her bladder before performing the maneuver so that she will be comfortable and the contour of the fetus is not obscured.
- Put the woman in a comfortable position with her knees flexed. Drape the patient and place a pillow under her head. Explain the procedure to the patient and answer any questions that she may have.
- Make sure that the hands are warm before coming in contact with the patient’s abdomen. Rub the hands together vigorously to prevent uterine contractions and use the palm of the hand instead of the fingers.
- The nurse should stand with the body facing the patient during the first three maneuvers and facing the feet of the patient during the final maneuver.
Common Side Effects and Complications from Performing Leopold Maneuvers
There are virtually no side effects or complications of the Leopold Methods. A skilled nurse should execute the procedure and care should be taken not to disturb the fetus in an excessive manner. The method can be painful for the expectant mother if the nurse performing the maneuvers is does not take care to perform the procedure properly.
Performing the 4 steps of the Leopold Maneuvers requires skill and patients to locate the position of the mother’s fetus. The maneuvers should be performed in a manner that is comfortable to the expectant mother.