OBJECTIVE This study aims to clarify whether the sonographic assessment of the fetal occipital and spine positions before a labour induction and during labour are related to delivery outcomes. METHODS This prospective study involved 350 women carrying singleton normal fetuses in cephalic presentation, wherein fetal occiput and fetal spine positions were initially assessed via transabdominal ultrasound before induction of labour. Subsequently, these positions were reevaluated during the first stage of labour, while monitoring labour progress conventionally. Delivery mode and both maternal and fetal outcomes were then carefully documented and analysed. RESULTS Induction was conducted using dinoprostone (prostin E2) or Pitocin, chosen based on cervical favourability. Before the induction of labour, 24.3% of fetuses were observed in the occiput posterior position, while 16.3% were noted to be in the posterior spine position. During the first stage of labour, fetal occipital posterior and fetal spine posterior positions were documented at 16.1% and 10.3%, respectively. A significant association was found between fetal occiput and spine positions during the first stage of labour and various obstetric outcomes, including mode of delivery, duration of labour, the incidence of postpartum hemorrhage, and admission to neonatal intensive care. (p< 0.05). CONCLUSION The presence of fetal occipitoposterior position and fetal spine posterior during the first stage of labour after induction of labour is linked to an increased likelihood of caesarean section. Moreover, a significant correlation was found between the fetal occiput and spine positions during the first stage of labour and the duration of labour, as well as the occurrence of postpartum haemorrhage and admission to the neonatal intensive care unit.