The labor and delivery nurse is performing a vaginal examination to assess for cervical dilation and effacement. While palpating the presenting fetal part, the nurse feels a diamond-shaped structure that feels soft in the middle. What is the nurse's best action?

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11ecbb05_cc05_1bba_b433_594e837d441e_MD0009_00 The nurse is most likely palpating the diamond-shaped anterior fontanelle of the fetal head, which is in cephalic (ie, head down) presentation. Therefore, the nurse should document the fetal presentation as cephalic. The posterior fontanelle is triangular and separated from the anterior fontanelle by the sagittal suture. By identifying the location of these fetal skull landmarks, an experienced examiner can determine the fetal head position, or the direction the occiput is facing. (Option A) With breech presentation, the fetal buttocks, legs, or feet may be palpated. Fetal buttocks do not feel as round, smooth, or firm as the head during vaginal examination. Although the anus could be mistaken for a fontanelle, the anal sphincter feels firmer to palpation than a fontanelle and is circular, rather than triangular or diamond shaped. (Option C) A prolapsed cord would feel soft and rubbery on palpation and may be pulsating. If the cord is prolapsed, an emergency cesarean delivery is usually required. (Option D) Palpating the anterior fontanelle should reassure the nurse that the fetus is in a cephalic presentation, so there is no indication for informing the health care provider. Educational objective: Fetal head position can be determined by the sutures and fontanelles (eg, diamond-shaped anterior fontanelle) of the fetal skull.

The Labor and Delivery Nurse Is Performing a Vaginal Examination