Ultrasound can also rule out fetal abnormalities, low placenta, hyperextension of the baby's head, and the presence of the umbilical cord around the neck of the fetus. If in doubt about the presentation part, obstetric ultrasound should be used to confirm the results of the palpation. Uterine contractions, the size of the pregnant uterus, any uterine masses, and attitude, presentation, degree of commitment of the fetus, and any fetal-pelvic disproportions can be detected.Ībdominal palpation is accurate in identifying the presentation, mainly if performed by experienced healthcare professionals. It offers the possibility of collecting data on an area, structure, or function by touch. Palpation is the contact of the operator's fingers and hands with the body of the woman or child. It is recommended for confirmation when any malpresentation is even slightly suspected. Therefore ultrasonographic examination remains the current gold standard investigation for ensuring the fetus is in the cephalic presentation during the third trimester of pregnancy. However, the accuracy of Leopold maneuvers varies depending on many factors, especially examiner experience. Īccurate assessment of fetal presentation and position is crucial in guiding obstetric management. The underutilized external cephalic version and intrapartum planning and consenting are choices that can be discussed. Detection of malpresentation in late pregnancy allows for counseling on adequate care measures. It is essential to detect non-cephalic presentations before the onset of labor to mitigate the maternal and neonatal risks associated with complicated vaginal delivery or cesarean section. Malpresentation is estimated to occur in 5% of all deliveries and is an essential cause of the high cesarean delivery rate. Spontaneous vaginal delivery is most common when a cephalic-presenting fetus is in the occiput anterior position. Malpresentations are all presentations of the fetus other than vertex, which includes the breech presentation, transverse and oblique lie. Malpositions are abnormal positions of the vertex of the fetal head, using the occiput as the reference point, relative to the maternal pelvis.
The commonest presentation is the vertex of the fetal head. When the fetal head is approaching the pelvic inlet, it is referred to as a cephalic presentation. It is used to determine the position, presentation, and engagement of the fetus in utero.įetal presentation refers to the fetal anatomic part proceeding first into the pelvic inlet. This method of abdominal palpation is of low cost, easy to perform, and non-invasive. Four classical maneuvers are used to palpate the gravid uterus systematically.
The Leopold maneuvers, named after the German obstetrician and gynecologist Christian Gerhard Leopold (1846–1911), are part of the physical examination of pregnant women.
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