Manœuvres de Léopold

In obstetrics, Leopold maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus. They are named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight. The maneuvers consist of four distinct actions, each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and lie of the fetus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether a caesarean section is necessary. The examiner's skill and practice in performing the maneuvers are the primary factor in whether the fetal lie is correctly ascertained. Alternately, position can be determined by ultrasound performed by a sonographer or physician. Leopold maneuvers are difficult to perform on obese women and women who have polyhydramnios. The palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider should first ensure that the woman has recently emptied her bladder. If she has not, she may need to have a straight urinary catheter inserted to empty it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised slightly on a pillow and her knees drawn up a little. Her abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. While facing the woman, palpate the woman's upper abdomen with both hands. An obstetrician can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, round, and moves independently of the trunk while the buttocks feel softer, are symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk.