Leopold Maneuvers

Leopold maneuvers are begun in midpregnancy through labor to assess the fetus and maternal abdomen (Figure 6-2). Consist of four parts:

First maneuver answers the question: "What fetal part occupies the fundus?"

Second maneuver answers the question: "On what side is the fetal back?" Third maneuver answers the question: "What fetal part lies over the pelvic inlet?"

Fourth maneuver answers the question: "On which side is the cephalic prominence

Five aspects of the fetus are described from the Leopold maneuvers:

■ Presentation

FIGURE 6-2. Leopold maneuvers. Determining fetal presentation (A and B), position (C), and engagement (D).

(Reproduced, with permission, from Pernoll ML. Benson & Pernoll's Handbook of Obstetrics and Gynecology, 10th ed. New York: McGraw-Hill, 2001: 159.)

Station

Station describes the degree of descent of the fetal head (or presenting part) in relation to ischial spines.

Terminology (Two Systems)

1. The ischial spine is zero station, and the areas above and below are divided into thirds. Above the ischial spines are stations -3, -2, and -1, with -3 being the furthest above the ischial spines and -1 being closest. Positive stations describe fetal descent below the ischial spines. +3 station is at the level of the introitus, and +1 is just past the ischial spines.

2. Very similar except that the areas above and below the ischial spines are divided by centimeters, up to 5 cm above and 5 cm below. Above are five stations or centimeters: -5, -4, -3, -2, and -1, with -5 being the 5 cm above the ischial spines and -1 being 1 cm above. Positive stations describe fetal descent below the ischial spines. +5 station is at the level of the introitus, and +1 is 1 cm past the ischial spines.

The level of the presenting part is described in relation to the ischial spines, which are designated as level 0.

Lie describes the relation of the long axis of the fetus to that of the mother. Can be either:

■ Longitudinal (99% of term or near term births). This can be vertex (head first) or breech (buttocks first).

Presentation/Presenting Part

Presentation describes the portion of the fetus that is foremost within the birth canal. It is normally determined by palpating through the cervix on vaginal examination.

■ If the lie is longitudinal, the presentation is either the head (cephalic) or buttocks (breech). One type of cephalic presentation is the vertex presentation in which the posterior fontanel is the presenting part. This is considered normal.

■ If the lie is transverse, the shoulder is the presenting part.

The Fetal Skull

The top of the fetal skull is composed of five bones: two frontal, two parietal, and one occipital. The anterior fontanel lies where the two frontal and two parietal meet, and the posterior fontanel lies where the two parietal meet the occipital bone.

If the fetus is vertex, the presenting part should be measured at the biparietal diameter (BPD), not at the tip-top of the head, which may simply be caput and not the head at all. So when the BPD is at the level of the ischial spines, the station is 0.

Anterior fontanel: bigger diamond shape Posterior fontanel: smaller triangle shape

Fetal Positions

Position refers to the relation of the presenting part to the right (R) or left (L) side of the birth canal and its direction anteriorly (A), transversely (T), or posteriorly (P).

For a cephalic occipital presentation, the position can be described in the following ways:

Occipital anterior (OA) Occipital posterior (OP) Left occipital anterior (LOA) Left occipital posterior (LOP)

Interpreting Fetal Positions: Imagine the mother lying in the anatomical position and the baby's occiput in relation to her body. You are at the end of the bed looking between mom's legs. Figure 6-3 represents the mother's birth canal with the fetal head inside in various positions as you look at the fetal head.

FIGURE 6-3. Vertex presentations.

(Reproduced, with permission, from Lindarkis NM, Lott S. Digging Up the Bones: Obstetrics and Gynecology. New York: McGraw-Hill, 1998:28.)

Left occipital transverse (LOT) Right occipital anterior (ROA) Right occipital posterior (ROP) Right occipital transverse (ROT)

Fetal Attitude and Posture

In the later months of pregnancy, the fetus assumes a characteristic posture ("attitude/habitus"), which typically describes the position of the arms. Examples include arms folded over thorax or parallel to the sides.

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