Predicting fetal weight. Are Leopold's maneuvers still worth teaching to medical students and house staff?

OBJECTIVE

To assess the value of teaching Leopold's maneuvers to medical students and house staff physicians for the purpose of estimating term fetal weight.

STUDY DESIGN

Forty-four patients between 37 and 42 weeks of gestation were asked to estimate their fetus's weight upon presentation for delivery. A medical student or house staff physician then performed Leopold's maneuvers to assess fetal weight manually. For comparison, a previously published birth weight prediction equation was used to calculate fetal weight based upon maternal and pregnancy-specific characteristics alone, and obstetric ultrasonography was performed to measure fetal biometric parameters for use with standard ultrasonic fetal weight prediction equations.

RESULTS

House staff physicians performed significantly better than medical students in making fetal weight predictions to within +/- 10% of actual birth weight using Leopold's maneuvers (71% vs. 38%, P < .05). House staff who made tactile assessments of fetal weight were able to predict birth weight to within 15% of actual weight more often than mothers making estimations (P < .05), but medical students could not (P = .53). The correlation between predicted and actual birth weights was .60 for Leopold's maneuvers, .45 for maternal estimates of fetal weight, .55 for the birth weight prediction equation and .63 for the best of eight ultrasonic prediction equations tested.

CONCLUSION

House staff physicians make more accurate predictions of term fetal weight using Leopold's maneuvers than do medical students. This is presumably due to the increased experience of house staff in using such tactile techniques. Leopold's maneuvers are a useful method of estimating fetal weight and should continue to be taught to both medical students and house staff.