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What are the 4 Leopold Maneuvers?

¿Cuáles son las 4 Maniobras de Leopold?If you are pregnant or a mom, you probably know Leopold’s maneuvers although not necessarily by that name. These maneuvers handle the determination and position of the fetus in the womb and it is usually possible to perform them from the third trimester.

It is very important to mention from the beginning that none of these actions should be done at home, or with a family member or acquaintance who is not an expert in the subject. Always remember to go with the specialists, this article is merely informative.

Leopold’s maneuvers are named after Christian Gerhard Leopold, a German obstetrician who lived from 1846 to 1911.

Nurses or midwives use this process along with the evaluation of the shape of the maternal pelvis to evaluate the positions of the fetus, the descent, and the amount of amniotic fluid, in this way with all this information they can determine if complications will occur during childbirth and if the patient will require a cesarean section.

Leopold maneuvers consist of four maneuvers or actions, by palpation an obstetrician examines your abdomen from the outside to see how your pregnancy progresses. This is the most common form of abdominal palpation in pregnant women in obstetrics.

The maneuvers have four specific techniques to perform.

In the first trimester, the uterus fills the small pelvis but barely rises above the symphysis. To determine the position of the fetus and the position of the present part, it is advisable to perform echograms of the uterus systematically. Depending on several factors, Leopold Maneuvers can be performed from 28 weeks. However, they charge a higher semiological value from the 32nd week of gestation.

Before visiting the midwife for an external exam, it is important that you have an empty bladder. Not only is this more enjoyable for you, but it allows the midwife to feel your abdomen better and the exam is more reliable.

In the womb, a fetus has a presentation and a position. The presentation refers to the way the baby’s body is expected to exit through the birth canal. To determine this the maneuvers are of great help.

There are 4 simple Leopold maneuvers for this purpose:

First maneuver What is the part of the presentation? Fundus.

Using both hands and looking at the pregnant woman, the upper abdomen (uterus) is palpated to establish which end of the fetus (fetal pole) is at the top of the uterus. With this method, you can determine the shape, size, mobility, and consistency of what you feel. So it allows identifying if the fetus is in a cephalic or pelvic presentation.

If the head or buttocks of the fetus are on the bottom, then the fetus is upright. Otherwise, the fetus is most likely in a transverse position.

Second maneuver. Fetal orientation

Firm pressure is applied to the sides of the abdomen to establish the location of the spine and limbs. It is used to determine the position of the fetus’ back.

The fetal back can be identified as a convex, hard, and resistant mass by palpation. While the opposite side will be palpated as irregular masses and its consistency will be variable.

Third maneuver. Fetal presentation

It is used to confirm fetal presentation and to determine if the fetus is in a cephalic or buttock position.

Using the thumb and fingers of one hand, the lower abdomen is grabbed just above the pubic symphysis to establish if the part that is presented is occupied. If it is not busy, a moving part of the body will be felt. The part that occurs is the part of the fetus that feels closest to the birth canal.

Having women a 36-week exam can help prevent undiagnosed breech births, which can be dangerous for both mother and baby. However, it is important to note that the presentation of the buttocks can occur after a 36-week scan because some babies have an unstable position, which means they change position easily, even after 36 weeks. Normally, the pelvic presentation can be diagnosed by Leopold maneuvers and then confirmed with ultrasound. In the case of a breech presentation, you can decide whether to try an external version or plan a C-section.

Fourth maneuver. Degree of descent

The Fourth Leopold Maneuver is the only one of the four maneuvers in which the midwife must be placed on her back to the patient. Therefore, when facing the feet of the pregnant woman, use the tips of the fingers to apply deep pressure in the direction of the axis of the pelvic outlet. If the head occurs, one hand is stopped before the other by a rounded body (the cephalic prominence) while the other hand descends deep into the pelvis.

If the cephalic prominence is on the same side as the small parts, then the fetus is in vertex presentation. The presentation at the apex is the “normal” way a baby is positioned for delivery and the presentation of the lowest risk for vaginal delivery.

If the cephalic prominence is on the same side as the back, then the head is extended and the fetus is in face presentation. some babies present differently before delivery and it is very important to take this into account in advance so that, as I said before, we can plan the delivery in the most appropriate way.

So the third and fourth maneuvers complement each other to determine the degree of fetal fit in the cephalic presentation.

Tips for performing Leopold maneuvers

– Going to the bathroom and emptying your bladder before performing the maneuvers will help you to feel comfortable and the consultation is more effective.

– Get comfortable with your knees bent and place a pillow under your head. The midwife will explain the procedure and answer any questions you may have.

– The midwife must stand with the body facing the patient during the first three maneuvers and facing the patient’s feet during the last maneuver.

Common Side Effects and Complications of Performing Leopold Maneuvers

We can say that there are usually no side effects or complications in performing Leopold maneuvers. A specialized midwife should perform the procedure and care should be taken not to disturb the fetus excessively. The method does not have to be painful for the future mother if the midwife performing the maneuvers does it correctly. Therefore, this type of examination during pregnancy should only be performed by a professional.



All the information we give you in this article is indicative since each woman and each family are different and unique.


Carolina González Ramos

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