# Situation: A 26-year-old primigravida at 39 weeks' gestation is admitted to the labor room of a district hospital. The hospital monitors labor with the traditional modified World Health Organization (WHO) partograph used in the Department of Health (DOH) Essential Intrapartum and Newborn Care (EINC) module, which starts plotting the active phase at 4 cm of cervical dilation. Her membranes are intact, and her prenatal course was uncomplicated. On admission at 08:00, vaginal examination shows the cervix 4 cm dilated with the vertex presenting. The examiner feels the diamond-shaped fontanel toward the mother's left and posterior. How should the nurse classify the fetal position? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=629475 > language: ko > subject: Nursing Practice II — Maternal and Child Health Nursing ## 문제 Situation: A 26-year-old primigravida at 39 weeks' gestation is admitted to the labor room of a district hospital. The hospital monitors labor with the traditional modified World Health Organization (WHO) partograph used in the Department of Health (DOH) Essential Intrapartum and Newborn Care (EINC) module, which starts plotting the active phase at 4 cm of cervical dilation. Her membranes are intact, and her prenatal course was uncomplicated. On admission at 08:00, vaginal examination shows the cervix 4 cm dilated with the vertex presenting. The examiner feels the diamond-shaped fontanel toward the mother's left and posterior. How should the nurse classify the fetal position? ## 보기 1. Right occiput anterior (ROA) **✔ 정답** 2. Left occiput anterior (LOA) 3. Right occiput posterior (ROP) 4. Left occiput posterior (LOP) **정답: 1** ## 해설 The diamond-shaped fontanel is the anterior fontanel, at the front of the fetal head, so the occiput lies at the opposite point. With the anterior fontanel toward the mother's left posterior pelvis, the occiput points to her right anterior pelvis. The position is therefore right occiput anterior. ## 심화 해설 Fetal position interpretation The examiner palpated the diamond-shaped fontanel, which is the anterior fontanel. Because the anterior fontanel sits at the front of the fetal head, the occiput is always located at the opposite point of the skull. When the anterior fontanel is felt toward the mother’s left posterior pelvis, the occiput must therefore point toward the mother’s right anterior pelvis. The fetal position is named by the direction of the occiput, not by the fontanel that is palpated. In this case, the occiput is directed to the maternal right and anterior, so the position is right occiput anterior (ROA). The vertex is presenting, and the occiput is the landmark used for describing cephalic positions. Key point! If the examiner feels the anterior fontanel, mentally rotate 180 degrees to locate the occiput before naming the position. Why this matters in labor Occiput anterior positions are the most favorable for vaginal delivery because the fetal head presents with the smallest diameter and rotates through the pelvis most efficiently. In contrast, occiput posterior (OP) positions are the most common malposition and are associated with prolonged labor, operative delivery, and cesarean section [1]. The active phase of labor tends to be longer with OP than with OA positions [2]. OP may complicate up to 35% of initial labors, although many fetuses rotate spontaneously to an anterior position during labor [3]. The traditional modified WHO partograph used in the DOH EINC module begins active-phase plotting at 4 cm of cervical dilation. Accurate identification of fetal position at admission helps the nurse anticipate labor progress and recognize when a persistent malposition may be contributing to slow dilation or descent. Digital examination remains the conventional bedside method for assessing fetal position, though intrapartum ultrasound and deep learning models are being studied to improve accuracy [1][4]. Watch out! Do not confuse the side of the fontanel with the side of the occiput. The anterior fontanel and the occiput are on opposite sides of the fetal head. If the anterior fontanel is left posterior, the occiput is right anterior, making the position ROA, not LOP or LOA.References (research sources) - [1]Artificial Intelligence Dystocia Algorithm (AIDA) for Risk Stratification of Occiput Posterior Fetal Head Position.Research articleMalvasi A, Baldini GM, Difonzo T, Cara I, Cerbone M, Dellino M, Vimercati A, Mappa I, Rizzo G, Tinelli A, Cicinelli E, Naro ED, Malgieri LE. (2026) · DOI: 10.3390/jimaging12060230 - [2]Associations between fetal position at delivery and duration of active phase of labor: A historical cohort study.Research articleEide B, Sande RK, Von Brandis P, Kessler J, Tappert C, Eggebø TM. (2024) · DOI: 10.1111/aogs.14929 - [3]Rebozo and maternal postures to prevent persistent occiput posterior position of the fetal head: protocol for a randomised clinical trial 'the ReMaP-POPP RCT'.RCT/clinical trialOrnaghi S, Fumagalli S, Antolini L, Panzeri M, Spandrio R, Ferrini S, Nespoli A, Maini M, Locatelli A. (2025) · DOI: 10.1136/bmjopen-2025-103520 - [4]A deep learning approach to identify the fetal head position using transperineal ultrasound during labor.Research articleRamirez Zegarra R, Conversano F, Dall'Asta A, Giovanna Di Trani M, Fieni S, Morello R (2024) · DOI: 10.1016/j.ejogrb.2024.08.012 ## 임상 시나리오 Fetal Position: Anterior Fontanel to OcciputLocate the occiput 180 degrees from the palpated fontanel The diamond-shaped anterior fontanel marks the front of the fetal head. The occiput is always at the opposite point. If the anterior fontanel is felt toward the maternal left posterior pelvis, the occiput points to the maternal right anterior pelvis. Name the position by the occiput, not the fontanel. Occiput right anterior = Right Occiput Anterior (ROA). ROA is the most favorable cephalic position for vaginal delivery. CautionDo not record the position as left posterior based on the fontanel. Always mentally rotate 180 degrees to locate the occiput before naming the position. Occiput posterior positions are associated with prolonged labor and operative delivery. ## 핵심 개념 - **Anterior fontanel** — Diamond-shaped membrane-covered space at the junction of the frontal and parietal bones; located at the front of the fetal head. - **Occiput** — Back part of the fetal skull; the landmark used to name cephalic fetal positions. - **Right occiput anterior (ROA)** — Fetal position in which the occiput is directed toward the maternal right anterior pelvis; favorable for vaginal delivery. - **Occiput posterior (OP)** — Fetal malposition with the occiput directed toward the maternal posterior pelvis; associated with prolonged labor and operative delivery. - **Vertex presentation** — Cephalic presentation with the fetal head fully flexed; the occiput is the presenting landmark. ## 같은 주제 문제 - [Situation: A 24-year-old primigravida at 39 weeks' gestation comes to a lying-in clinic at…](https://mymerci.kr/pages/nclex_q.php?qn_id=629374) - [Situation: A 24-year-old primigravida at 39 weeks' gestation comes to a lying-in clinic at…](https://mymerci.kr/pages/nclex_q.php?qn_id=629375) - [Situation: A 24-year-old primigravida at 39 weeks' gestation comes to a lying-in clinic at…](https://mymerci.kr/pages/nclex_q.php?qn_id=629376) - [Situation: A 24-year-old primigravida at 39 weeks' gestation comes to a lying-in clinic at…](https://mymerci.kr/pages/nclex_q.php?qn_id=629377) - [Situation: A 28-year-old woman at 40 weeks' gestation, who had one previous term vaginal b…](https://mymerci.kr/pages/nclex_q.php?qn_id=629378) - [Situation: A 28-year-old woman at 40 weeks' gestation, who had one previous term vaginal b…](https://mymerci.kr/pages/nclex_q.php?qn_id=629379) - [Situation: A 28-year-old woman at 40 weeks' gestation, who had one previous term vaginal b…](https://mymerci.kr/pages/nclex_q.php?qn_id=629380) - [Situation: A 28-year-old woman at 40 weeks' gestation, who had one previous term vaginal b…](https://mymerci.kr/pages/nclex_q.php?qn_id=629381) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._