🩺 Abdominal Examination (Leopold’s Maneuver)

---

✅ I. Introduction / Definition:

Leopold’s Maneuvers are a series of four systematic abdominal palpations performed during antenatal examination to assess the position, lie, presentation, and engagement of the fetus in the uterus.

✅ “Leopold’s maneuvers are clinical techniques used by healthcare providers to determine fetal presentation and position through abdominal palpation.”

---

👩‍⚕️ II. Purpose of Leopold Maneuvers:

🔹 Determine fetal lie (longitudinal, transverse, oblique)
🔹 Identify fetal presentation (cephalic, breech)
🔹 Locate the position of the fetal back
🔹 Assess fetal engagement in the pelvis
🔹 Guide in planning for safe delivery

---

📍 III. Prerequisites Before Performing:

🟢 Explain procedure to mother
🟢 Ensure she has emptied her bladder
🟢 Place mother in dorsal recumbent position with knees flexed
🟢 Expose abdomen appropriately
🟢 Warm your hands to avoid uterine contraction

---

✋ IV. The Four Leopold’s Maneuvers:

---

🔹 1st Maneuver – Fundal Grip

🔸 Purpose: Identify the part in the fundus
🔸 Technique: Palpate upper abdomen with both hands
🔸 Findings:

• Head: Hard, round, ballotable
• Breech: Soft, irregular, not ballotable

---

🔹 2nd Maneuver – Lateral Grip

🔸 Purpose: Locate the fetal back
🔸 Technique: Palpate both sides of abdomen simultaneously
🔸 Findings:

• Back: Smooth, firm surface
• Limbs: Irregular, nodular, may move

---

🔹 3rd Maneuver – Pawlik’s Grip

🔸 Purpose: Identify presenting part above the pelvic inlet
🔸 Technique: Grasp lower abdomen just above symphysis pubis
🔸 Findings:

• Head: Firm, round, movable
• Engagement: If not mobile → likely engaged

---

🔹 4th Maneuver – Pelvic Grip (Facing mother’s feet)

🔸 Purpose: Determine degree of engagement
🔸 Technique: Use both hands to press downward above pubis
🔸 Findings:

• If fingers diverge → head is not engaged
• If fingers converge → head is engaged in pelvis

---

🧾 V. Interpretation from Leopold Maneuvers:

🟣 Aspect Assessed	🔍 How It’s Determined
Lie	Longitudinal or transverse by 1st & 2nd maneuver
Presentation	Cephalic or breech by 1st & 3rd maneuver
Position	Left or right side of the back by 2nd maneuver
Engagement	Whether presenting part has descended into pelvis – 3rd & 4th maneuver

---

👩‍⚕️ VI. Nursing Responsibilities:

🟩 During Antenatal Care:
🔹 Perform Leopold’s maneuver from 28–32 weeks onward
🔹 Record findings and fetal heart sounds (FHS)
🔹 Explain findings to mother in simple language

🟨 After Examination:
🔹 Monitor maternal well-being and fetal movement
🔹 Prepare referral if malpresentation or non-engagement in late term
🔹 Educate about importance of regular check-ups

---

📚 Golden One-Liners for Quick Revision:

🟡 Fundal grip tells what’s in the fundus
🟡 Lateral grip identifies fetal back and limbs
🟡 Pawlik’s grip confirms fetal presenting part
🟡 Pelvic grip checks if the head is engaged
🟡 Bladder must be emptied before examination

---

✅ Top 5 MCQs for Practice:

---

Q1. Which Leopold maneuver is used to identify the fetal back?
🅰️ First
✅ 🅱️ Second
🅲️ Third
🅳️ Fourth
Correct Answer: 🅱️ Second

---

Q2. Which part of the fetal body feels soft and irregular during the first maneuver?
🅰️ Head
✅ 🅱️ Breech
🅲️ Spine
🅳️ Abdomen
Correct Answer: 🅱️ Breech

---

Q3. Which maneuver is also known as Pawlik’s grip?
🅰️ First
🅱️ Second
✅ 🅲️ Third
🅳️ Fourth
Correct Answer: 🅲️ Third

---

Q4. The fetal head is said to be engaged when:
🅰️ It is ballotable
🅱️ It moves upward freely
✅ 🅲️ It is fixed and not movable
🅳️ It is felt at the fundus
Correct Answer: 🅲️ It is fixed and not movable

---

Q5. Before performing Leopold’s maneuver, what should the nurse ensure first?
🅰️ Patient eats a light meal
✅ 🅱️ Bladder is emptied
🅲️ Blood pressure is normal
🅳️ FHS is audible
Correct Answer: 🅱️ Bladder is emptied