Identify the following image. Which of the following is the maneuver being depicted in the image?

NORCET 7 Prelims -2024

Obstetrics & Gynaecology

Easy

Appeared in: NORCET 7 Prelims -2024

Explanation

The image shows a single hand grasping the lower uterine segment just above the symphysis pubis.
This technique is known as Pawlik's Grip, which is the third of Leopold's maneuvers.
The purpose of this maneuver is to identify the fetal presenting part and assess its mobility and engagement in the maternal pelvis.
The round, hard, and ballottable (movable) feel of the fetal head is being assessed in the image.

Option A: The First Maneuver, or Fundal Grip, involves using both hands to palpate the top of the uterus (fundus) to determine which fetal part is located there. The image shows a single hand on the lower abdomen.
Option B: The Second Maneuver, or Lateral Grip, involves placing both hands on either side of the abdomen to locate the fetal back and small parts (limbs). The image shows only one hand being used in the midline.
Option C: The Fourth Maneuver, or Pelvic Grip, requires the examiner to face the woman's feet and use the fingertips of both hands to press into the lower abdomen towards the pelvic inlet to assess descent. The image shows the examiner facing the woman's head and using one whole hand.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The concept tested is the identification of the specific steps of Leopold's maneuvers, which are used in obstetrics to determine fetal presentation, lie, and position as background academic context rather than a clinical decision trigger.
Leopold's maneuvers are a fundamental, non-invasive clinical skill for nurses and midwives to assess fetal lie, presentation, position, and engagement.
The findings from these maneuvers help in anticipating the course of labor and planning for a safe delivery, including identifying malpresentations like breech or transverse lie that may require intervention.
Accurate performance and interpretation can reduce the need for routine ultrasound in low-risk pregnancies to determine fetal position before labor.

How to Approach the Question

First, carefully observe the image provided. Pay close attention to the number of hands being used and their exact placement on the pregnant abdomen.
Note the specific action being performed: in this case, a single hand is grasping the lower abdomen just above the pubic bone.
Recall the four Leopold's maneuvers and the specific technique for each one.
Compare the action in the image to the definition of each maneuver: First (Fundal Grip), Second (Lateral Grip), Third (Pawlik's Grip), and Fourth (Pelvic Grip).
The image clearly shows a single-handed grasp of the lower uterine segment, which corresponds directly to the definition of the Third Maneuver (Pawlik's Grip).
Eliminate the other options based on their differing techniques (e.g., use of two hands, placement at the fundus, or examiner facing the patient's feet).

Concept Tested & Keywords

Concept Tested: The concept tested is the identification of the specific steps of Leopold's maneuvers, which are used in obstetrics to determine fetal presentation, lie, and position.
Stem keywords: image, maneuver, depicted
Lead-in keywords: Identify, Which of the following
Clinical cues: Single hand grasping lower abdomen

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