A client at 39 weeks' gestation presents for a routine visit. Leopold's maneuvers reveal a hard, round mass in the fundus, a smooth curve on the client's left side, irregular small parts on the right, and a softer, irregular mass above the pubic symphysis. Which fetal position is most consistent with these findings?
- A.Vertex presentation, LOA (left occiput anterior)
- B.Breech presentation, LSA (left sacrum anterior)
- C.Vertex presentation, ROA (right occiput anterior)
- D.Transverse lie
Show answer & rationale
Correct answer
B. Breech presentation, LSA (left sacrum anterior)
Rationale
B is correct: Leopold's maneuvers: (1) Hard, round mass in the fundus = head (vertex), indicating breech presentation because the head is at the top. (2) Smooth curve on left = the back. (3) Irregular small parts on right = extremities. (4) Soft, irregular mass above pubic symphysis = the buttocks presenting. This is breech presentation with the back on the left, consistent with LSA. A is incorrect: In a vertex presentation, the hard, round head would be at the pubic symphysis (bottom of the uterus), not the fundus. C is incorrect: Same reasoning as A, vertex presentation has the head presenting at the pelvis. D is incorrect: A transverse lie would not have a clearly defined pole in the fundus or pelvis along the vertical axis.
Key concepts