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A series of manoeuvres used to determine the position of a fetus by palpating the abdomen. From the test, a skilled physician can determine the fetal lie, presentation, and position. It is named after Christian G. Leopold, a German gynecologist who described the sequence in 1894.

Performing the Test

  1. 1st Maneouvre
    • Stand at the side of the bed, facing the woman's head
    • With fingers together, use both hands to palpate the upper pole of the fundus
    • Usually the fetal buttocks will occupy the fundus, feeling soft and irregular
    • If breech, the fetal head will be palpated and feels firm, round, smooth and more mobile/ballottable



  2. 2nd Maneouvre
    • Hands are placed on either side of abdomen
    • One hand will stabilize the uterus so the other can palpate the fetus
    • Palpate to determine on which side of the abdomen the fetal back lies
    • Back will feel smooth and firm, while the extremities will feel like irregular bumps



  3. 3rd Maneouvre
    • Palpate the lower pole of the uterus by placing one hand just above the symphysis pubis
    • Thumb and fingers are used to grasp presenting part, usually head
    • If presenting part is ballotable, it is not yet engaged.



  4. 4th Maneouvre
    • While facing the woman's feet, place hands on each side of lower abdomen
    • Exert a deep pressure towards the pelvic inlet
    • One hand usually encounters some resistance (does not descend as far) due to the cephalic prominence
    • If this is on the same side as fetal parts, the head is flexed
    • If this is on same side as fetal back, the head is extended



Interpretation and Notes

  • Used to determine fetal lie, presentation and position
  • Useful in the 3rd trimester
  • May be more difficult in cases of obesity, polyhydramnios, or when the placenta has implanted anteriorly
  • When used by an experienced clinician:
    • Sensitivity: 88%
    • Specificity: 94%
    • Positive predictive value: 74%
    • Negative predictive value: 97%

References

  1. Cunningham FG, Leveno KJ, Bloom SL, Hauth JC, Rouse DJ, Spong CY. Williams Obstetrics. 23rd ed. New York: McGraw-Hill; 2010.
  2. Lydon-Rochelle M, Albers L, Gotwocia J, Craig E, Qualls C. Accuracy of Leopold maneuvers in screening for malpresentation: a prospective study. Birth. 1993;20:132-135.