# A multigravida at 39 weeks gestation is in active labor. During vaginal examination, the nurse palpates the fetal head at -1 station with the sagittal suture running anteroposterior and the posterior fontanelle easily palpated anteriorly. What fetal position does this assessment indicate?

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> subject: Maternal Newborn Health

## 문제

A multigravida at 39 weeks gestation is in active labor. During vaginal examination, the nurse palpates the fetal head at -1 station with the sagittal suture running anteroposterior and the posterior fontanelle easily palpated anteriorly. What fetal position does this assessment indicate?

## 보기

1. Left occiput anterior (LOA) **✔ 정답**
2. Right occiput anterior (ROA)
3. Left occiput posterior (LOP)
4. Right occiput posterior (ROP)

**정답: 1**

## 해설

Posterior fontanelle palpated anteriorly indicates an anterior position; sagittal suture anteroposterior confirms LOA. In posterior positions (LOP/ROP), the anterior fontanelle is palpated anteriorly.

## 심화 해설

Clinical Judgment
This question assesses fetal position, a Core Concept for determining the baby's location during labor. The key is connecting two Critical Cues from the vaginal examination: 1) the posterior fontanelle is easily palpated anteriorly, and 2) the sagittal suture runs in an anteroposterior direction. A posterior fontanelle located anteriorly means the fetal occiput is facing the anterior part of the maternal pelvis. At this point, an occiput anterior (OA) position is confirmed. Next, you must determine whether the occiput is on the left or right side. With the sagittal suture running anteroposteriorly and the posterior fontanelle anterior, the direction (left or right) where the posterior fontanelle is palpated indicates the occiput's location. The problem only states "the posterior fontanelle was easily palpated anteriorly" without specifying left or right, but LOA is the most common normal position and best fits these findings. If it were ROA, the posterior fontanelle would have been palpated on the right anterior side.

Memory Tip
Fetal position memory aid: Occiput + Side + Anterior/Posterior/Transverse. In other words, think in OSA order. It describes which side (S) the occiput (O) is on and whether it faces anterior (A), posterior (P), or transverse (T). LOA = Left side, Occiput, Anterior.

KR vs US
In Korea, fetal position is often expressed using Chinese characters, such as '좌전정횡위(LOT)', but on the NGN/NCLEX, English abbreviations (e.g., LOA, ROP) are used. Additionally, while ultrasound is often used as an adjunct in Korean practice to assess labor progress in primiparas, NCLEX scenarios frequently require you to make judgments based on the nurse's direct physical examination (vaginal exam) findings.

## 임상 시나리오

Clinical Practice Guide
Sequence for assessing fetal position during vaginal examination in labor: 1) Identify the fontanelle: anterior fontanelle (diamond-shaped) vs. posterior fontanelle (triangular). 2) Identify the direction of the sagittal suture. 3) Deduce the direction of the occiput: The occiput is located on the opposite side of where the posterior fontanelle is palpated. (Example: If the posterior fontanelle is palpated on the left anterior side → the occiput is on the right posterior side? No! Since the posterior fontanelle is itself on the occiput, the direction where the posterior fontanelle is palpated is the direction of the occiput. In LOA, the posterior fontanelle is palpated in the left anterior direction).

Caution
In SATA (Select All That Apply) questions, this may appear as "Findings confirming fetal occiput anterior (OA) position." The correct answers are "The posterior fontanelle is palpated anteriorly" and "The sagittal suture is in the anteroposterior direction." "The anterior fontanelle is palpated" is a sign of occiput posterior (OP) position, so it is a distractor.

## 핵심 개념

- **Station** — Station of the fetal head. A measure indicating how far the presenting part (head) has descended relative to the ischial spine. -1 means the presenting part is located 1 cm above the ischial spine, indicating it has not yet fully entered the pelvic cavity.
- **Sagittal Suture** — Sagittal suture. This is the suture line connecting the two parietal bones of the skull. During vaginal examination in labor, the direction of this suture is palpated to determine the orientation (station) of the fetal head, serving as an important landmark.
- **Posterior Fontanelle** — Posterior fontanelle (small fontanelle). A triangular soft tissue area located where the parietal bones and occipital bone meet. It is smaller than the anterior fontanelle and is a key landmark for determining fetal position during delivery (especially the direction of the occiput).
- **Occiput Anterior (OA)** — Occiput anterior position. This is a fetal position where the occiput (back of the head) faces the front of the mother's pelvis, making it the most favorable position for vaginal delivery. It is divided into left occiput anterior (LOA) and right occiput anterior (ROA).
- **Leopold's Maneuvers** — Leopold's maneuvers. A systematic four-step abdominal palpation method to assess fetal position, presentation, and attitude through the abdominal wall. Used to determine the approximate fetal position before and in early labor.

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