Clinical exam · Kidney, genitourinary, breast and obstetric exam

Leopold maneuvers !

Maneuver

Four hand maneuvers on a pregnant abdomen that show how the baby lies inside the uterus.

Updated 2026-11-01

See it in 3D: Fundus of uterus · Body of uterus · Lower uterine segment · Pubic symphysis

What it is

The Leopold maneuvers are four ordered palpations of the maternal abdomen, usually from about 32 weeks of gestation, that find the fetal lie (longitudinal, transverse or oblique), the presentation (cephalic or breech), the side of the fetal back and how far the presenting part has descended into the pelvis. They guide where to listen for the fetal heart and flag malpresentations that change the birth plan. They are a core skill in obstetric medicine and nursing.

The anatomy it tests

The fundus is the top of the uterus; its height grows with gestation and the first maneuver identifies the fetal pole lodged there.
The lower uterine segment and the maternal pelvis receive the presenting part; the third and fourth maneuvers assess its relation to the pelvic inlet.
The pubic symphysis is the landmark for the third maneuver; engagement happens when the widest diameter of the head passes the pelvic inlet.
The pillow under the right hip tilts the uterus off the inferior vena cava, preventing compression that would cause maternal hypotension.

How to do it

Preparation: explain and obtain consent, empty bladder, supine with knees slightly bent and a pillow under the right hip; warm hands.
First maneuver (fundus): facing the patient, both hands feel the fundus. Hard, round and ballotable is the head; soft and irregular is the buttocks.
Second maneuver (sides): hands on the sides of the uterus, one steadies, the other feels. A smooth, continuous surface is the back; small knobby parts, limbs.
The second maneuver sets the lie (longitudinal, transverse or oblique) and whether the back is on the mother's right or left.
Third maneuver (lower pole): one hand in a 'C' grasps the part just above the pubis: what presents, and does it move (not engaged) or stay fixed?
Fourth maneuver (engagement): the examiner turns to face the patient's feet and slides both hands down the sides of the uterus toward the pelvis.
Fourth maneuver: converging hands mean the head is not engaged; diverging hands mean it has descended. A brow opposite the back means a flexed head.
Finish by listening to the fetal heart over the fetal back and recording lie, presentation, position and engagement.

What a positive result means

Expected at term: longitudinal lie, cephalic presentation, a flexed head and, as labour nears, an engaged head.
Head in the fundus (first maneuver) and a soft pole above the pubis (third): breech presentation.
A wide uterus, fetal poles in both flanks and an empty pelvis: transverse lie with shoulder presentation, which rules out vaginal birth.
A head still not engaged late in a first pregnancy may suggest cephalopelvic disproportion or placenta previa.
An abnormal or doubtful presentation is confirmed by ultrasound.

Usefulness and limits

Accuracy is moderate and depends on experience; obesity, excess amniotic fluid, an anterior placenta, fibroids and contractions reduce it.
Obstetric ultrasound confirms the presentation when the exam is doubtful or abnormal.
Palpate between contractions; during a contraction the uterus is hard and fetal parts cannot be told apart.

Test yourself

Think of the answer, then tap the question to see it.

What does the first Leopold maneuver determine?

Which fetal pole lies in the fundus: the head (hard, round, ballots) or the buttocks (soft, irregular).

Which maneuver is done facing the patient's feet, and what does it assess?

The fourth; it assesses descent or engagement of the presenting part and flexion of the head.

Why does the side of the fetal back matter?

To listen to the fetal heart, which is heard best over the back.

What do fetal poles in both flanks and an empty pelvis suggest?

A transverse lie with shoulder presentation.

Add to my cards (4)

See it in 3D

The structures of Durgical's 3D anatomy where it is found.

← All of the clinical exam

Educational content on the clinical exam; it is learned and practised under supervision. It does not replace assessment by a health professional and is not for self-diagnosis.

Sources: 16.2 External and Internal Monitoring - Maternal Newborn Nursing | OpenStax (OpenStax, 2024); 11.4 Care in the Third Trimester of Pregnancy - Maternal Newborn Nursing | OpenStax (OpenStax, 2024); 18.1 Nursing Care During the First Stage of Labor - Maternal Newborn Nursing | OpenStax (OpenStax, 2024).

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.