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

Step 1: Interpret the clinical signs.

• Infraumbilical flattening (saucer-shaped depression below the umbilicus): This is a classical sign of occipitoposterior (OP) position. In OP position, the fetal back is directed posteriorly and the limbs are anteriorly placed, causing flattening of the maternal abdomen below the umbilicus and a characteristic limb-filled feeling on palpation anteriorly.
• Fetal heart rate heard laterally: In OP position, the fetal back is posterior. The fetal heart sounds are best heard in the flanks (lateral) rather than anteriorly, because the back (where the fetal heart is closest to the uterine wall) is directed posteriorly.

Step 2: Understand occipitoposterior position. In OP position, the occiput (back of the fetal head) faces the maternal sacrum. Abdominal examination shows:

• Flatness or depression below the umbilicus (due to anterior placement of fetal limbs)
• FHR best heard in the flanks or far laterally
• Midline groove may be felt (between the fetal head and back)

Step 3: Eliminate other options.

• Knee/Brow presentations: Do not produce infraumbilical flattening
• Right dorsoanterior: In dorsoanterior positions, the fetal back is anterior, so FHR would be heard anteriorly, not laterally

Conclusion: Infraumbilical flattening with lateral FHR = Occipitoposterior position.