Leopold’s Maneuvers: Determining Fetal Position in the Uterus

(A: First Maneuver: Determining the Fetal Part at the Fundus)
Facing the woman, place both hands at the upper portion of the abdomen to palpate the fundus to identify the fetal part occupying the upper part of the uterus.

Head: hard, firm, round, and moves independently of the trunk
Feet: soft, symmetrical
Shoulders&Limbs:small bony prominence, move with the trunk

(B: Second Maneuver: Determining the Position of Fetal Back)
Still facing the woman, palpate 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 uterus. 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

(C: Third Maneuver: Determining which Fetal Part is Lying above the Pelvic Inlet in the Lower Abdomen)
The area above the symphysis pubis is palpated with the thumb and third finger to determine the presenting fetal part. ***The Pawlick Grip is often abandoned in favor of a two hand palpation due to the discomfort it causes the Mother.

(D: Fourth Maneuver: Determining Location of Fetal Brow)
Facing the Mother’s feet the fingers of both hands are moved gently down the sides of the uterus toward the pubis. The side where there is the greatest resistance to the descent of the fingers toward the pubis 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. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back.One hand applies pressure on the fundus while the index finger and thumb of the other hand palpate the presenting part to confirm presentation and engagement [preferably, the fetal head]

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