Leopold's maneuvers (aka fetal palpation) are 4 maneuvers used to palpate a fetus inside a pregnant woman, from her abdomen.

FMF is shorthand for fetal movement felt.

• Determines position of the fetus
• Determines presentation of the fetus
• Assessment of the shape of the maternal pelvis can indicate whether delivery is going to be complicated, or whether C-section is necessary
• Also used to estimate term fetal weight

• Ensure that the woman has emptied her bladder → comfort
• Lie on her back with her shoulders raised slightly on a pillow, and knees drawn up a little. Abdomen uncovered
• 1st maneuver (Fundal palpation), using both hands to palpate the superior border of the fundus. Most pregnancies are longitudinal (99%), such that the head and buttocks are palpable at each end of the uterus. Fundal height can also be measured as the distance between the pubic symphysis and the superior border of the fundus, but should only be carried out after 20 weeks gestation
• 2nd maneuver (Lateral palpation), palpating the Pt's (R) side with your (L) hand, and the Pt's (L) side with your (R) hand
  • Feel for the lie of the fetus if it didn't seem to be longitudinal. Transverse lie is if the fetus is felt at right angles to the axis of the uterus. Oblique lie is if the head or buttocks are palpable on either side of the iliac fossa
  • Feel for the number of pregnancies
  • Feel for the spine/back of fetus, to determine fetal lie. It is the side the uterus feels "full", because although it isn't possible to feel fetal parts directly, as it is an irregularly shaped mass suspended in a bag of water, the "full" side corresponds to the back of the fetus due to increased resistance
  • Feel and estimate the amount of liquor, where if there is an excessive amount lf fluid, the uterus will be tense, and it will be quite difficult to feel for fetal parts
• 3rd/4th maneuver (Presentation palpation), using either:
  • Pelvic palpation, where both hands palpate the lower segment of the pelvis by pressing firmly on either side of the midline just above the pubic symphysis. Facing the end of the bed, use your (L) hand on the Pt's (L) side, and your (R) hand on the Pt's (R) side
  • Pawlick's grip, where using the thumb and index finger of the (R) hand, firmly grip the presenting fetal part between the fingers. NB: this may cause pain and discomfort
  • Palpating presentation assumes fetal lie is longitudinal, but can be breech or cephalic. In cephalic presentation, you can ballot the head by moving the head slightly from side to side. The head is usually quite firm compared to breech. Breech is harder to feel and cannot be balloted
  • Feel for engagement of the fetal head, dividing the fetal head into 1/5ths. If only 2/5ths of the head is palpable in the abdomen, this indicates the head is engaged into the pelvis (i.e. the widest diameter has descended into the pelvis)

Source: Fast bleep

• Can be uncomfortable for women if care is not taken to ensure she is relaxed, and adequately positioned

• It is difficult to perform the maneuvers on:
  • Obese women
  • Women with polyhydramnios
• It is named after the gyencologist Christian Gerhard Leopold

• Fetal U/S (another method to determine position)