This is the most common lie of fetuses in labor. If the fetus and maternal column are parallel (on the same long axis), the lie is termed vertical or longitudinal lie. Using the techniques described above, the clinician should be able to develop an assessment of the relationship between the fetal and maternal dorsal columns (the longitudinal axis of the human body). The ultrasound should be 100% accurate in diagnosing the type of fetal presentation. If the presenting part is not easily palpable, it is important that further assessment be obtained by performing an ultrasound examination. The vaginal examination also allows the clinician to assess the degree of cervical dilation and effacement. The status of the amniotic membranes and the degree of engagement of the presenting part are indicators of fetal presentation and position. This maneuver should allow the identification of the fetal parts in the lower pole of the uterus.Īfter the abdominal examination, a digital vaginal examination is performed. The palms of both hands are placed on either side of the lower maternal abdomen, with the fingertips facing toward the pelvic inlet. Maneuver IV: This last maneuver resembles the first one, but instead of facing the fundus, the examiner faces the pelvis of the patient. This will allow the examiner to develop a further identification of the presenting part and assessment of its engagement. This is done on the lower abdomen, a few centimeters above the symphysis pubis. Maneuver III: Using one hand, the examiner will grasp the presenting part between the thumb and fingers. With this maneuver, the examiner will be able to determine the location of the fetal back. Maneuver II: Once an assessment is made of the fetal part present in the uterine fundus, the hands are placed at either side of the maternal abdomen. This should allow the identification of the fetal parts in the upper pole (fundus) of the uterus. The fundus is palpated with the fingertips of both hands facing toward the maternal xiphoid cartilage. Maneuver I: The uterine contour is outlined. (Pritchard JA, MacDonald PC: William's Obstetrics, 16th ed. The fetus is in a left occiput anterior position. What follows is a description of these maneuvers:įig. The accuracy of Leopold's maneuvers can be hampered by the maternal body habitus, the presence of uterine fibroids, multiple gestations, or polyhydramnios. Through use of Leopold's maneuvers, a clinical estimate of the fetal weight also can be obtained, although this is not a formal part of this examination. In addition, a clinical estimate of the degree of engagement of the presenting part could be made, although the final determination of engagement must be made by way of a vaginal examination. The examiner may be able to palpate the presenting part. Leopold's maneuvers 1 consist of an abdominal examination divided into four steps of palpation of the gravid uterus and fetus (Fig. The obstetrician should be able to determine the fetal lie, presentation, and position, using the maternal vertebral column and pelvis as reference points, by Leopold's maneuvers, vaginal examination, and if necessary, ultrasound. To assess the potential impact of the fetus on the characteristics of the labor process, it is important that the obstetrician be knowledgeable of the basic concepts used routinely to describe how the body of the fetus is located in the uterus.
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