While performing a vaginal examination for a woman who is in labor process, you can feel the scapula of the fetus. What fetal presentation is expected in this case?

1. A

   Vertex presentation

2. B

   Face Presentation

3. C

   Shoulder presentation

4. D

   Breech presentation

Appeared in: RUHS, Jaipur, PB B.Sc Nursing Entrance-2019

Explanation

• The question states that the scapula is felt during a vaginal examination.
• The scapula, or shoulder blade, is the primary bony landmark of the fetal shoulder.
• When the fetus is positioned horizontally in the uterus (transverse lie), the shoulder is the part that enters the pelvic inlet first.
• Therefore, palpating the scapula confirms a shoulder presentation.

Why Other Options Were Wrong

• Option A: In a vertex presentation, the fetal head is the presenting part. The examiner would feel the hard surface of the skull, along with the sutures and fontanelles.
• Option B: In a face presentation, the fetal head is hyperextended. The examiner would feel the distinct features of the fetal face, such as the nose, mouth, and orbital ridges.
• Option D: In a breech presentation, the fetal buttocks or feet are the presenting part. The examiner would feel soft tissue (buttocks), the ischial tuberosities, and possibly the anus or feet.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of fetal presentation via vaginal examination landmarks as background academic context rather than a clinical decision trigger.
• Shoulder presentation is an obstetric emergency because a vaginal delivery is impossible for a term-sized fetus, necessitating a cesarean section.
• Nurses must recognize the signs of shoulder presentation promptly to facilitate immediate medical intervention and prevent complications like cord prolapse, obstructed labor, and uterine rupture.
• What if you felt the soft buttocks and ischial tuberosities instead? The presentation would be breech. Management would then depend on factors like the type of breech, fetal size, and pelvic adequacy, with options including external cephalic version, planned cesarean, or, in select cases, a planned vaginal breech delivery.

How to Approach the Question

• First, identify the key clinical finding provided in the question stem, which is 'you can feel the scapula of the fetus'.
• Next, relate this specific anatomical part to a larger body region. The scapula is the shoulder blade.
• Connect this body region to the corresponding fetal presentation. If the shoulder is the presenting part, it is a shoulder presentation.
• Finally, confirm your answer by mentally reviewing the palpable landmarks for the other options. Vertex involves feeling the skull/fontanelles, face involves facial features, and breech involves the buttocks/sacrum. Since the scapula was felt, shoulder presentation is the only correct choice.

Concept Tested & Keywords

• Concept Tested: Identification of fetal presentation via vaginal examination landmarks.
• Stem keywords: vaginal examination, labor, scapula, fetal presentation
• Lead-in keywords: What
• Clinical cues: Palpation of the scapula is the key diagnostic finding.

Question ID

QHujbUVUhSlK8Y2x4tS6RP

Copy ID

Reference Book

E6 Obstetrics Williams pp. 19-36, 20-36

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 44-52