Question

Patient with infraumbilical flattening and fetal heart rate heard laterally, what is the presentation?

• A. Occipitoposterior
• B. Knee
• C. Brow
• D. Right dorsoanterior

Hint:

In which fetal position does the fetal back face posteriorly, causing flattening below the umbilicus and laterally heard fetal heart sounds?

Answer 1

The Correct Option is A

Topic: Fetal presentation and position -- clinical diagnosis.

Clinical findings:
- Infraumbilical flattening (saucer-shaped depression below umbilicus)
- Fetal heart rate (FHR) heard laterally (in the flanks)

Explanation:
In Occipitoposterior (OP) position, the fetal occiput faces the maternal sacrum. The fetal back is directed posteriorly (toward the mother's spine), placing the fetal limbs anteriorly.

Abdominal signs of OP position:
1. Infraumbilical flattening -- limbs lie anteriorly, no rounded back present anteriorly
2. FHR heard in flanks/laterally -- fetal back is posterior, so the region closest to the fetal heart (chest/back) is far from the anterior abdominal wall
3. Head may feel deflexed on palpation
4. Maternal discomfort: severe backache (back labor) is common

In dorsoanterior positions: fetal back is anterior $\rightarrow$ FHR heard anteriorly and clearly.
In OP: fetal back posterior $\rightarrow$ FHR lateral or poorly heard anteriorly.

Incidence of OP: $\sim$10% of all deliveries. Most rotate to OA during labor (long internal rotation). Persistent OP may require operative delivery.

\[\boxed{\text{Occipitoposterior}}\]