NCLEX Review Guide: Leopold's Maneuvers

Purpose and Timing

• Leopold's maneuvers are systematic palpation techniques performed during the third trimester to determine fetal presentation, position, and engagement status.
• These maneuvers are typically performed after 28 weeks gestation when the fetus is large enough to accurately assess position and presentation.

First Maneuver - Fundal Grip

1. Place both hands on fundus with fingertips facing downward
2. Palpate to determine which fetal part occupies the fundus
3. Breech feels firm and irregular; head feels hard, round, and ballotable

Second Maneuver - Umbilical Grip

1. Place hands on either side of abdomen at umbilical level
2. Apply gentle but firm pressure to locate fetal back and small parts
3. Fetal back feels smooth and firm; small parts feel irregular and mobile

Third Maneuver - Pawlik's Grip

1. Grasp presenting part with thumb and fingers just above symphysis pubis
2. Determine if presenting part is engaged or floating
3. If head is engaged, it cannot be moved; if floating, it can be balloted

Fourth Maneuver - Pelvic Grip

1. Turn to face maternal feet, place hands on lower abdomen
2. Move hands downward toward pelvic inlet
3. Determine degree of flexion and descent of presenting part

Assessment Preparation

• Position client supine with knees slightly flexed to relax abdominal muscles and improve palpation accuracy.
• Ensure maternal comfort by placing small pillow under right hip to prevent supine hypotension syndrome.

Quick Check

Can you identify all four Leopold's maneuvers in sequence?
Do you understand the difference between presentation and position?
Can you interpret engagement versus floating findings?