Completing the Assessment
The third and fourth maneuvers of Leopold's technique provide crucial information about fetal positioning and engagement. The Pawlik's Grip (3rd Maneuver) determines if the presenting part is engaged in the pelvis by grasping the lower portion of the abdomen with thumb and finger, then making gentle side-to-side movements.
During the Pelvic Grip (4th Maneuver), you'll face the foot part of the woman and press downward about 2 inches above the inguinal ligament to assess the degree of flexion of the fetal head. This tells you about the fetal attitude or habitus—whether the head is well-flexed (good attitude) or hyperextended (poor attitude).
The 4th maneuver also helps determine the baby's anteroposterior position. If the brow is easily palpated, the fetus is likely in a posterior position, with the back of the head (occiput) pointing toward the mother's back. This information is particularly valuable for anticipating labor progress and potential complications.
Remember: A properly engaged presenting part will feel fixed or less movable, while an unengaged part will still be freely movable above the pelvic inlet.