Leopold Maneuvers - By Dr Sakshi Arora Hans

Fundal Height Examination and Gestational Age Estimation
📌 The Fundal Height Examination is performed using the ulnar border of the left hand, starting from the symphysis pubis to determine the upper border of the uterus.
🤰 In the presented case, the fundal height indicated a position two-thirds of the distance from the umbilicus to the xiphisternum, suggesting the patient is 32 or 40 weeks pregnant (confirmed as 40 weeks).

Leopold's First Maneuver (Fundal Grip)
✋ This maneuver is performed while facing the patient's face to palpate the fundal area gently.
🍑 Feeling a broad and smooth structure indicates the baby's buttocks are in the fundal area, suggesting a cephalic presentation (head down).
↔️ If something is felt in the fundal grip, it confirms a longitudinal lie; an empty grip suggests a transverse lie.

Leopold's Second Maneuver (Umbilical Grip)
🖐️ Performed by moving hands to the lateral sides of the umbilicus, stabilizing one side while palpating the other.
🦴 Feeling multiple nodular structures on one side indicates the limbs, while a continuous board-like structure indicates the baby's back.
↖️ Since the back was on the left side, the occiput position was determined to be Left Occiput Anterior (LOA) or Left Occiput Transverse (LOT).

Leopold's Third Maneuver (Pelvic Grip)
👆 A single hand is placed above the pubic symphysis to feel the presenting part.
⚾ Feeling a hard, firm, globular structure confirms cephalic presentation.
⬇️ This maneuver assesses ballotability: if the head cannot be moved side-to-side, it means the head has entered the pelvis and is fixed.

Leopold's Fourth Maneuver (Deep Pelvic Grip)
🔄 Performed while facing the patient's feet, using parallel fingers along the inguinal ligament to palpate the presenting part.
🧐 This maneuver reconfirms the presentation and determines if the head has entered the pelvis (fixed).
🤏 The degree of palpability (e.g., $5/5$, $4/5$, $3/5$, $2/5$ palpable) indicates how far the head has descended; engagement occurs when the head is $2/5$ palpable abdominally or less.

Key Points & Insights
➡️ Leopold's maneuvers must be performed with the patient's bladder adequately emptied and ensuring hands are warmed for patient comfort.
➡️ The First Maneuver determines Lie and Presentation based on what is felt in the fundus (broad/smooth = buttocks; hard/firm = head).
➡️ The Second Maneuver determines the Position by locating the fetal back (where the occiput will be positioned).
➡️ Engagement (head descent into the pelvis) usually occurs around 38 weeks in primigravida patients, but at the onset of labor in multigravida patients.
➡️ Sub-pubic flattening (flattening below the umbilicus) suggests Occipitoposterior position, whereas the typical anterior position allows fetal heart sounds to be heard close to the umbilicus.

📸 Video summarized with SummaryTube.com on Jan 06, 2026, 17:11 UTC