Superville Shervonne S., Siccardi Marco A.
Henry Ford Health
San Paolo Hospital Savona
The Leopold maneuvers are a systematic method of abdominal palpation used to assess fetal position, presentation, and engagement during the third trimester of pregnancy. Four classical maneuvers are used to palpate the gravid uterus systematically. This abdominal palpation method is low-cost, easy to perform, and noninvasive. The Leopold maneuvers, developed by German obstetrician and gynecologist Christian Gerhard Leopold (1846–1911), have traditionally been used to assess fetal position, presentation, and lie and estimate fetal weight. Fetal presentation refers to the position of the fetal anatomic part closest to the pelvic inlet. The cephalic presentation is the most common and is characterized by the fetal head positioned at the pelvic inlet. Other presentations include breech and shoulder, in which the fetal buttocks or feet and the fetal shoulder are closest to the material pelvic inlet. Fetal lie refers to the position of the fetal spine relative to the maternal spine, including longitudinal, transverse, and oblique. Spontaneous vaginal delivery is most common when a cephalic-presenting fetus is in the occiput anterior position. Breech presentation is the most common malpresentation, with an incidence of 3% to 4% of fetal deliveries. Identifying noncephalic presentations before the onset of labor is essential to mitigate the maternal and neonatal risks associated with complicated vaginal delivery or cesarean section. Detection of malpresentation in late pregnancy allows for counseling on adequate care measures. Leopold maneuvers are also used to estimate fetal weight, although the accuracy is debated. In a study, clinical estimation of fetal weight overestimated birth weight in 58.2% of patients and underestimated birth weight in 41.2%. Fetal macrosomia, typically defined as a fetal weight of ≥4000 g, is associated with a high risk of birth injury, shoulder dystocia, and brachial plexus injury. Clinical estimation of fetal weight to identify fetal macrosomia aids clinicians and patients in making informed management decisions. Evaluating fetal weight, presentation, and position is crucial in guiding obstetric management. However, the accuracy of Leopold maneuvers varies depending on many factors, especially examiner experience. Therefore, an ultrasonographic examination is typically used to support clinical estimations of fetal weight and to determine whether the fetus is in the cephalic presentation during the third trimester of pregnancy. This technique is recommended to confirm the diagnosis when any malpresentation is even slightly suspected.
利奥波德手法是一种系统的腹部触诊方法，用于评估妊娠晚期胎儿的位置、先露和入盆情况。该方法通过四个经典手法对妊娠子宫进行系统触诊。这种腹部触诊方法成本低、操作简便且无创。利奥波德手法由德国妇产科医生克里斯蒂安·格哈德·利奥波德（1846 - 1911）发明，传统上用于评估胎儿的位置、先露和胎产式，并估计胎儿体重。胎儿先露是指胎儿最靠近骨盆入口的解剖部位的位置。头先露是最常见的，其特征是胎儿头部位于骨盆入口处。其他先露包括臀先露和肩先露，其中胎儿臀部或足部以及胎儿肩部最靠近母体骨盆入口。胎儿胎产式是指胎儿脊柱相对于母体脊柱的位置，包括纵产式、横产式和斜产式。当头先露胎儿处于枕前位时，自然阴道分娩最为常见。臀先露是最常见的异常先露，占胎儿分娩的3%至4%。在分娩开始前识别非头先露对于降低与复杂阴道分娩或剖宫产相关的母体和新生儿风险至关重要。在妊娠晚期检测到异常先露可为适当的护理措施提供咨询。利奥波德手法也用于估计胎儿体重，尽管其准确性存在争议。在一项研究中，临床估计胎儿体重时，58.2%的患者高估了出生体重，41.2%的患者低估了出生体重。巨大胎儿通常定义为胎儿体重≥4000g，与出生损伤、肩难产和臂丛神经损伤的高风险相关。临床估计胎儿体重以识别巨大胎儿有助于临床医生和患者做出明智的管理决策。评估胎儿体重、先露和位置对于指导产科管理至关重要。然而，利奥波德手法的准确性因许多因素而异，尤其是检查者的经验。因此，在妊娠晚期，通常使用超声检查来辅助临床估计胎儿体重，并确定胎儿是否为头先露。当甚至略微怀疑有任何异常先露时，建议使用这种技术来确诊。
