Maternity Nursing: Intrapartum Q 34

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Which of the following fetal positions is most favorable for birth?

  

     A. Vertex presentation

     B. Transverse lie

     C. Frank breech presentation

     D. Posterior position of the fetal head

    

    

Correct Answer: A. Vertex presentation

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Vertex presentation (flexion of the fetal head) is the optimal presentation for passage through the birth canal. Toward the end of pregnancy, the fetus moves into position for delivery. Normally, the position of a fetus is facing rearward (toward the woman’s back) with the face and body angled to one side and the neck flexed, and presentation is head first.

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Option B: Transverse lie is an unacceptable fetal position for vaginal birth and requires a C-section. In transverse lie, the fetus lies horizontally across the birth canal and presents shoulder first. A cesarean delivery is done, unless the fetus is the second in a set of twins. In such a case, the fetus may be turned to be delivered through the vagina.

Option C: Frank breech presentation, in which the buttocks present first, can be a difficult vaginal delivery. When delivered vaginally, babies that present buttocks first are more likely to be injured than those that present head first. Such injuries may occur before, during, or after birth. The baby may even die. Complications are less likely when breech presentation is detected before labor or delivery.

Option D: Posterior positioning of the fetal head can make it difficult for the fetal head to pass under the maternal symphysis pubis. In occiput posterior presentation (also called sunny-side up), the fetus is head first but is facing up (toward the mother’s abdomen). It is the most common abnormal position or presentation. When a fetus faces up, the neck is often straightened rather than bent, and the head requires more space to pass through the birth canal. Delivery by a vacuum extractor or forceps or cesarean delivery may be necessary.

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