During the assessment of a laboring client, the nurse notes that the FHT are loudest in the upper-right quadrant. The infant is most likely in which position?
A. Right breech presentation
B. Right occiput anterior presentation
C. Left sacral anterior presentation
D. Left occiput transverse presentation
Correct Answer: A. Right breech presentation
If the fetal heart tones are heard in the right upper abdomen, the infant is in a breech presentation. A breech position is not ideal for delivery. Though the majority of breech babies are born healthy, they may have a higher risk of birth defects or trauma during delivery. This position can also be problematic because it increases the risk of forming a loop in the umbilical cord that could cause injury to the baby if they’re delivered vaginally.
Option B: If the infant is positioned in the right occiput anterior presentation, the FHTs will be located in the right lower quadrant, so answer B is incorrect. The baby is head down, with their face facing the mother’s back. The baby’s chin is tucked into their chest and their head is ready to enter the pelvis. The baby is able to flex their head and neck, and tuck their chin into their chest. This is usually referred to as occipito-anterior, or the cephalic presentation.
Option C: If the fetus is in the sacral position, the FHTs will be located in the center of the abdomen, so answer C is incorrect. Left Sacrum Anterior (LSA) means the fetal sacrum is closest to the mother’s symphysis and rotated slightly to the mother’s left (clockwise from direct SA).
Option D: If the FHTs are heard in the left lower abdomen, the infant is most likely in the left occiput transverse position, making answer D incorrect. This LOT (Left, Occiput, Transverse) position and its’ mirror image, ROT, are common in early labor. As labor progresses and the fetal head descends, the occiput usually rotates anteriorly, converting this LOT to an LOA or OA as the head delivers.