North American Registry of Midwives (NARM) Practice Exam

In a face presentation, which cephalic prominence is palpated during the fourth Leopold's maneuver?

1. The forehead

2. The occiput

3. The chin

4. The vertex

The correct answer is: The occiput

In a face presentation, the position of the fetal head is distinctive, and identifying the correct cephalic prominence during the fourth Leopold's maneuver is critical. In this scenario, palpating the occiput is expected when assessing a face presentation. During the fourth Leopold's maneuver, the practitioner applies pressure to the lower uterine segment while facing the mother's head. In a face presentation, the fetal chin is positioned toward the cervix, and the occiput, which is the back of the head, is directed toward the stomach or front of the mother's body. The prominence of the occiput should be felt on one side of the abdomen during this assessment. Moreover, the forehead, chin, and vertex are not palpated in the same way during this maneuver since the face presentation alters the typical landmarks you would expect to feel in vertex presentations. Thus, correctly identifying the occiput allows the practitioner to confirm the presentation and positioning of the fetus, which is vital for planning the appropriate care for the laboring person.