North American Registry of Midwives (NARM) Practice Exam

What is the cephalic prominence during the fourth Leopold's maneuver in a well flexed cephalic presentation?

1. The chin

2. The sinciput

3. The occiput

4. The forehead

The correct answer is: The sinciput

In a well flexed cephalic presentation, the cephalic prominence refers to the most prominent part of the fetal head that can be palpated during the fourth Leopold's maneuver. When the fetus is in a well flexed position, this typically means that the fetal chin is tucked down towards the chest, and as a result, the sinciput, which is the area of the forehead and the anterior part of the skull, becomes the most prominent area. During the fourth Leopold's maneuver, the examiner feels the fetal head at the pelvic inlet to determine the position of the fetus. In a well flexed position, the occiput that normally leads doesn't extend to the prominence seen when the head is more extended or tilted backward. Instead, the sinciput presents as the prominent part due to its position. Thus, the cephalic prominence during this maneuver is identified as the sinciput. Understanding the dynamics of fetal positions and presentations is crucial in midwifery practice, as it aids in assessing labor progress and potential interventions needed during delivery.