Maternal & Newborn · Topic 6 of 58
Leopold Maneuvers & Fetal Position
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Leopold Maneuvers & Fetal Position
Four steps of abdominal palpation that find the fetal lie, presentation, position, engagement and attitude before you place the fetal heart rate monitor. A transverse lie can't be born vaginally at term.
Before: prepare the client
Empty bladder · hip wedge prevents supine hypotension · between contractions
Obesity, polyhydramnios and a full bladder make palpation findings less reliable.
The four maneuvers
Top, sides, bottom — then face the client's feet
Third maneuver: little or no movement of the presenting part means it is engaged. Fourth maneuver: slide both hands toward the pubic bone; brow felt opposite the back means a well-flexed head.
What's in the fundus?
The part in the fundus is the part that is not presenting
| Head in fundus | Buttocks in fundus | |
|---|---|---|
| Feels | Hard, round, movable | Softer, less defined |
| Presentation | Breech | Cephalic |
| Transducer | Above the umbilicus, over the back | Lower abdomen (vertex), over the back |
Fetal position terms
Lie · presentation · position · attitude · station
Lie compares the fetal long axis with the client's. Position relates the presenting part's landmark (the occiput for a vertex) to the client's pelvis; other landmarks are the sacrum for breech, mentum (chin) for face and acromion for shoulder. At term over 95% lie longitudinally; about 97% present cephalic, 3% breech and under 1% shoulder.
Red flags
Occiput posterior (the back of the fetal head against the client's sacrum) is the most common malposition, about 15–30% of cephalic presentations; back labor care is in Labor Dystocia. Leopold maneuvers are sensitive (about 93%) but not specific (about 30%): ultrasound confirms presentation when findings are unclear.
Nursing priorities
Whatever sits in the fundus is not presenting — a hard, round head up top means breech, so listen above the umbilicus. Place the transducer over the fetal back, and report a transverse lie.
Sources · Maternal-Newborn Nursing 16.2: External and Internal Monitoring (OpenStax) · Nursing Cheat Sheet: Leopold Maneuver (Lecturio) · Maternal-Newborn Nursing 15.1: Factors Influencing the Process of Labor and Birth (OpenStax) · Fetal Presentation, Position, and Lie (MSD Manual Professional) · Maternal-Newborn Nursing 18.1: Nursing Care During the First Stage of Labor (OpenStax) · Fetal presentation (MedlinePlus) · Backache in Labor (University of Washington Medical Center) · Maternal-Newborn Nursing 19.3: Obstetrical Conditions Affecting Labor and Birth (OpenStax) · Follow your facility's protocol for fetal monitoring.
Leopold Maneuvers & Fetal Position
Leopold maneuvers are four steps of abdominal palpation that find the fetal presentation, lie, position, engagement and attitude before the nurse places the fetal heart rate monitor. First the client empties the bladder and lies supine with the knees slightly flexed and a wedge under one hip to prevent supine hypotension, and the nurse warms the hands and palpates between contractions. The first maneuver feels the fundus: a hard, round, movable head there means a breech presentation, while softer buttocks mean a cephalic one. The second finds the smooth, firm fetal back opposite the small, irregular extremities. The third grasps the presenting part above the symphysis pubis, and if it moves freely it is not engaged. The fourth, facing the client's feet, judges descent and flexion. The transducer goes over the fetal back: in the lower abdomen for a vertex, above the umbilicus for a breech. Occiput anterior is the most common and most favorable position, occiput posterior causes back labor, and a transverse lie, which cannot be born vaginally at term, is reported to the provider.
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