📘 Important for Obstetric & Midwifery Nursing, Labor Assessment, and Clinical Practice
Fetal lie refers to the relationship between the long axis of the fetus and the long axis of the mother’s uterus.
✅ “Fetal lie is the alignment of the fetal spine relative to the maternal spine, which helps determine the presentation and aids in the conduct of labor.”
| 🔍 Type | 🧠 Description |
|---|---|
| Longitudinal Lie | Fetal spine is parallel to the maternal spine (most common) |
| Transverse Lie | Fetal spine is perpendicular to the maternal spine (at 90° angle) |
| Oblique Lie | Fetal spine is at an angle between longitudinal and transverse (diagonal) |
🟢 Most favorable for vaginal delivery
🔹 Can result in cephalic (head down) or breech (buttocks down) presentation
🛑 Not favorable for vaginal delivery
🔹 Shoulder is the presenting part
🔹 Requires cesarean section if persists in labor
🔸 Unstable; may convert into longitudinal or transverse lie
🔸 Seen in preterm pregnancies or with polyhydramnios
| 💡 Factor | 🔍 Influence on Fetal Lie |
|---|---|
| Uterine shape & tone | Anomalies may prevent longitudinal lie |
| Amniotic fluid volume | Polyhydramnios may allow abnormal lie |
| Fetal number | Multiple pregnancy can distort lie |
| Placental location | Low-lying placenta may cause transverse lie |
| Parity | Grand multipara may have more unstable lie due to weak muscles |
🩺 Performed using Leopold’s maneuvers
🔹 1st and 2nd maneuvers help determine lie
🔹 Confirmed by ultrasound scan
🟩 Assessment:
🔹 Perform abdominal palpation to assess lie
🔹 Monitor fetal movements and heart sounds
🔹 Record findings in antenatal records
🟨 Intervention:
🔹 Refer if transverse or unstable lie after 36 weeks
🔹 Support obstetrician in external cephalic version (ECV) if needed
🔹 Prepare for cesarean section if non-vertex presentation persists
🟥 Education:
🔹 Explain importance of fetal position for delivery
🔹 Encourage antenatal visits and fetal monitoring
🟡 Fetal lie = alignment of fetal spine with maternal spine
🟡 Longitudinal lie is most common and favorable
🟡 Transverse lie requires cesarean delivery
🟡 Oblique lie is unstable and may change
🟡 Leopold’s maneuver helps detect lie clinically
Q1. Fetal lie refers to the relationship between:
🅰️ Fetal head and maternal pelvis
🅱️ Fetal heart and maternal heart
✅ 🅲️ Fetal spine and maternal spine
🅳️ Fetal limbs and maternal abdomen
Correct Answer: 🅲️ Fetal spine and maternal spine
Q2. Which type of fetal lie is most favorable for vaginal delivery?
🅰️ Transverse
✅ 🅱️ Longitudinal
🅲️ Oblique
🅳️ Variable
Correct Answer: 🅱️ Longitudinal
Q3. In transverse lie, the presenting part is usually:
🅰️ Head
🅱️ Buttocks
✅ 🅲️ Shoulder
🅳️ Foot
Correct Answer: 🅲️ Shoulder
Q4. Oblique lie is commonly seen in:
🅰️ Term pregnancies
✅ 🅱️ Preterm pregnancies
🅲️ Elderly women
🅳️ Hypertensive mothers
Correct Answer: 🅱️ Preterm pregnancies
Q5. Best method to confirm fetal lie is:
🅰️ Palpation
🅱️ Fetal heart auscultation
✅ 🅲️ Ultrasound
🅳️ Speculum examination
Correct Answer: 🅲️ Ultrasound
📘 Essential for Obstetric Nursing, Antenatal Assessment & Labor Management
Fetal presentation refers to the part of the fetus that lies over the cervical opening (internal os) and is first felt during a vaginal examination.
✅ “Fetal presentation is the part of the fetus that occupies the lower pole of the uterus and is first to engage in the birth canal during labor.”
| 🩺 Presentation | 📍 Description |
|---|---|
| Cephalic (Head) | Head presents first (most common – ~96%) |
| Breech (Pelvis) | Buttocks or feet present first |
| Shoulder (Transverse) | Shoulder or arm presents (rare, <1%) |
| 🧠 Type | 📌 Presenting Part | 📏 Engaging Diameter |
|---|---|---|
| Vertex (Flexed) | Occiput | Suboccipitobregmatic (9.5 cm) |
| Sinciput (Partially flexed) | Bregma | Occipitofrontal (11.5 cm) |
| Brow (Extended) | Forehead | Mentofrontal (13.5 cm) |
| Face (Hyperextended) | Face/Chin (Mentum) | Submentobregmatic (9.5 cm) |
✅ Vertex presentation is most favorable for vaginal delivery.
🛑 Brow and face presentations may require cesarean section depending on position and progress.
| 🍼 Type | 🔍 Description |
|---|---|
| Complete Breech | Flexed thighs and knees – buttocks and feet present |
| Frank Breech | Flexed hips, extended knees – buttocks present |
| Footling Breech | One or both feet present first |
🛑 Breech deliveries carry higher risk of cord prolapse, injury, and fetal distress.
🔹 Fetal shoulder presents first
🔹 Fetal lie is transverse
🔹 Delivery is not possible vaginally
🔹 Requires cesarean section
🩺 Abdominal Palpation (Leopold’s maneuvers)
🩺 Vaginal examination during labor
🩺 Ultrasound scan – most accurate method
🩺 Fetal heart sound location (best heard over fetal back)
🟩 Assessment:
🔹 Monitor fetal lie and presentation during antenatal visits
🔹 Assist in Leopold’s maneuvers
🔹 Identify malpresentation early (breech, brow, shoulder)
🟨 Intervention:
🔹 Prepare for external cephalic version (ECV) if indicated
🔹 Arrange for cesarean section in non-vertex presentations
🔹 Monitor fetal well-being and labor progress closely
🟥 Education:
🔹 Counsel mother on importance of regular antenatal check-ups
🔹 Educate on signs of labor and when to seek care
🔹 Discuss delivery options if abnormal presentation is detected
🟡 Presentation = part of fetus over the cervix
🟡 Vertex (flexed head) is ideal presentation
🟡 Face and brow presentations may need C-section
🟡 Breech increases risk of cord prolapse
🟡 Transverse lie = shoulder presentation → C-section
Q1. What is the most common fetal presentation?
🅰️ Breech
🅱️ Face
✅ 🅲️ Vertex
🅳️ Shoulder
Correct Answer: 🅲️ Vertex
Q2. In face presentation, the presenting part is:
🅰️ Occiput
🅱️ Bregma
🅲️ Forehead
✅ 🅳️ Chin (Mentum)
Correct Answer: 🅳️ Chin (Mentum)
Q3. Which cephalic presentation has the smallest engaging diameter?
🅰️ Brow
🅱️ Face
✅ 🅲️ Vertex
🅳️ Sinciput
Correct Answer: 🅲️ Vertex
Q4. In frank breech, which part presents first?
🅰️ Feet
✅ 🅱️ Buttocks
🅲️ Shoulder
🅳️ Head
Correct Answer: 🅱️ Buttocks
Q5. Shoulder presentation is commonly associated with:
🅰️ Longitudinal lie
🅱️ Oblique lie
✅ 🅲️ Transverse lie
🅳️ Breech presentation
Correct Answer: 🅲️ Transverse lie
📘 Essential for Antenatal Care, Labor Assessment, and Safe Delivery
Fetal position refers to the orientation of the presenting part of the fetus (usually the occiput in cephalic presentation) in relation to the maternal pelvis.
✅ “Fetal position describes the direction in which the fetal presenting part (e.g., occiput, sacrum) is facing within the maternal pelvis.”
The position is described using three-letter notation:
| 🔠 Letter | 🧭 Meaning |
|---|---|
| First | Side of maternal pelvis (Left or Right) |
| Second | Fetal landmark (Occiput (O), Sacrum (S), Mentum (M), Shoulder (Sc)) |
| Third | Location within maternal pelvis (Anterior (A), Posterior (P), Transverse (T)) |
| 🩺 Position Code | 🔍 Description |
|---|---|
| LOA | Left Occipito-Anterior – ✅ Most common & favorable |
| ROA | Right Occipito-Anterior – favorable |
| LOP | Left Occipito-Posterior – may cause prolonged labor |
| ROP | Right Occipito-Posterior – back labor likely |
| LOT/ROT | Occiput towards transverse plane |
| 📌 Presentation | 📍 Position Examples |
|---|---|
| Breech | Left Sacro-Anterior (LSA), Right Sacro-Posterior (RSP) |
| Face | Left Mentum Anterior (LMA), Right Mentum Posterior (RMP) |
| Shoulder | Left Scapulo-Anterior (LSA), Right Scapulo-Posterior (RSP) |
🔹 Determines progress of labor
🔹 Influences the mechanism of delivery
🔹 Malpositions (like occipito-posterior) may lead to:
• Prolonged labor
• Increased need for assisted or cesarean delivery
• Back pain during labor
🟢 1. Abdominal Palpation (Leopold’s maneuvers – esp. 2nd)
🟢 2. Vaginal Examination
• Feel sutures and fontanelles
• Occiput = triangular posterior fontanelle
• Brow = bregma (diamond-shaped anterior fontanelle)
🟢 3. Ultrasound Scan – confirms position accurately
🟩 Assessment:
🔹 Regular antenatal palpation and fetal monitoring
🔹 Early detection of malpositions (OP, OT)
🟨 Intervention:
🔹 Encourage optimal fetal positioning (e.g., forward-leaning exercises)
🔹 Prepare for assisted delivery or C-section if position is abnormal
🔹 Support pain relief and maternal comfort during back labor
🟥 Education:
🔹 Teach mother about signs of labor and positioning
🔹 Encourage regular antenatal visits and hydration
🟡 Fetal position describes fetal part facing mother’s pelvis
🟡 LOA is the most common and favorable position
🟡 Occipito-posterior (OP) leads to longer labor and back pain
🟡 Fontanelles help identify fetal position per vaginal exam
🟡 Second Leopold’s maneuver identifies fetal back
Q1. The most common and favorable fetal position is:
🅰️ ROP
✅ 🅱️ LOA
🅲️ LOT
🅳️ LSA
Correct Answer: 🅱️ LOA
Q2. In the term ‘ROP’, the letter ‘O’ stands for:
🅰️ Occiput
🅱️ Orbit
🅲️ Omentum
🅳️ Ovary
Correct Answer: 🅰️ Occiput
Q3. Occipito-posterior positions are associated with:
🅰️ Easy labor
✅ 🅱️ Prolonged and painful back labor
🅲️ Transverse lie
🅳️ Face presentation
Correct Answer: 🅱️ Prolonged and painful back labor
Q4. Which fetal landmark is used to identify breech presentation?
🅰️ Occiput
🅱️ Mentum
✅ 🅲️ Sacrum
🅳️ Shoulder
Correct Answer: 🅲️ Sacrum
Q5. Which of the following is used to confirm fetal position?
🅰️ BMI
🅱️ Hemoglobin
✅ 🅲️ Ultrasound
🅳️ Blood pressure
Correct Answer: 🅲️ Ultrasound