Engagement is indicated when the fetal head is aligned with which pelvic landmark?

• A. Ischial spines
• B. Pelvic inlet
• C. Sacral promontory
• D. Pubic symphysis

Answer: (A)

Engagement means the presenting part has descended to the pelvic brim and is at the level of the ischial spines, i.e., station 0. When the fetal head aligns with the ischial spines, it has entered the pelvis and is considered engaged, ready for further descent. The other landmarks mark different levels in the pelvis: the pelvic inlet is higher up and not yet at engagement; the sacral promontory is a posterior upper landmark; the pubic symphysis is further forward toward the outlet. So alignment with the ischial spines is the sign that the head is engaged.