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Part I
LEARNING OBJECTIVES
Explain the five factors that affect the labor process.
Describe the anatomic structure of the bony pelvis.
Recognize the normal measurements of the diameters of the pelvic inlet, cavity,
and outlet.
LEARNING OBJECTIVES
Review the anatomy and the normal measurements of the fetal skull.
Explain the significance of molding of the fetal head during labor.
Describe the cardinal movements of the mechanism of labor.
Assess the maternal anatomic and physiologic adaptations to labor.
Describe fetal adaptations to labor.
Labor
is the process by which the fetus & placenta are expelled from the uterus.
PARTS OF PELVIS
Types of Pelvis
PELVIS
Measurement:
Pelvic Inlet
A. Diagonal conjugate distance between sacral promontory and inferior margin of
the symphisis pubis =12.5 cm 13 cm
B. true conjugate/conjugate vera- distance between the anterior surface of the
sacral promontory and the superior margin of the symphisis pubis = 10.5 11 cm
Pelvis
Bi-ischial diameter/ intertuberous diameter transverse diameter of the pelvic
outlet. Ave. = 11 cm
The examiner use closed fist to measure the outlet.
PASSAGEWAY
C. Soft tissue (cervix, vagina): stretches and dilates under the force of
contractions to accommodate the passage of the fetus.
The Passenger
The Passenger
Fetal Head
Bones of Fetal Skull:
a.Parietal (2)
b.Frontal (2)
c.Occipital (1)
d. Temporal (2)
Bones of skull are joined by membranous sutures, which allow for overlapping or
molding of cranial bones during birth.
The PASSENGER
Fetal Head
Molding
Is the change in shape of the fetal skull produced by the force of uterine
contractions pressing the vertex against the not yet dilated cervix
Fetal Head
Sutures of the fetal skull are membranous spaces between the cranial
bones.
Fontanels is the intersection of cranial sutures & are used as landmarks
for internal examinations during labor to determine position of fetus.
Fetal Skull
The PASSENGER
Measurements- the shape of the fetal skull causes it to be wider in its AP diameter
than in its transverse diameter.
Transverse diameter
A. biparietal diameter 9.25 cm
B bitemporal diameter 8 cm
The PASSENGER
Measurements
AP diameter
A. suboccipitobregmatic from below occipital area to anterior fontanelle 9.5 cm
B. occipitofrontal from occiput to midfrontal bone 12 cm
C. occipitomental from occiput to the chin 13.5 cm
D. submentobregmatic 9.5 cm
The PASSENGER
The normal attitude is the head is flexed forward, with chin almost resting on
the chest. The arms and legs are flexed.
Fetal Presentation
A. Longitudinal Lie
1. Cephalic
Face Extension
chin Hyperextension
2. Breech
B. Transverse lie
shoulder flexion
Fetal Presentations
A. Vertex (full flexion)
B. Sinciput (moderate flexion[military attitude])
C. Brow (partial extension)
D. Face (poor flexion,complete extension)
The PASSENGER
Fetal Presentation
1. Cephalic Presentation
2. Breech Presentation(3%)
3. Shoulder Presentation
Position
Fetal Position
Position
First letter defines whether the landmark is pointing to the mothers right (R)
or left (L) side of pelvis.
Middle letter denotes fetal landmark;O for occiput, M for mentum or chin, S
for sacrum & A for acromion process.
Last letter defines whether the land mark points anteriorly (A), posteriorly (P),
or transversely (T)
Position
Possible Fetal Position
Occurs when the fetal presenting part enters true pelvis (inlet).
May occur two weeks before labor in primis; usually occurs at the beginning
of labor for multipara.
Station
Station 0=at the level of the ischial spine, synonymous with engagement
Station
Powers of Labor
Primary & secondary forces work together to achieve birth of fetus, & placenta.
Primary force uterine muscular contractions causing complete effacement &
dilatation of the cervix.
Powers of Labor
Uterine contractions
Effacement- is the shortening & thinning of the cervical canal as
distinct from the uterus exists; It is expressed in percentage
Dilatation- refers to the enlargement of the cervical canal to 10cm
primarily as a result of uterine contractions & secondarily due to
pressure of the presenting part & BOW.
Effacement & Dilatation
Effacement & Dilatation
Uterine Contractions
Powers of Labor
Intensity strength of contraction. May be mild, moderate or strong.It is measured
by the consistency of the fundus at the acme of contraction.
Powers continue
Powers of Labor
Duration length of contraction.
Frequency-time from beginning of one contraction to the beginning of the next
contraction
Powers of Labor
Uterine Contractions
Uterus is gradually differentiated into distinct portions:
1. Upper uterine segment-becomes thick & active to expel out fetus
2.Lower uterine segment becomes thin walled, supple & passive so that fetus can
be pushed out easily.
Powers of Labor
Physiological retraction ring is formed at the boundary of upper & lower segment.In
difficult labor when fetus is larger than cervical canal, the round ligaments of the
uterus become tense during dilatation & expulsion, causing an abdominal
indentation called Bandls pathological retraction ring, a danger sign of labor
signifying impending rupture of the uterus if the obstruction is not relieved.
Powers of Labor
Secondary force is the use of abdominal muscles to push during second stage of
labor.
Placenta
As the placenta usually forms in the fundus of the uterus, it seldom interferes with
the progress of labor.
A low-lying, marginal, partial or complete placenta previa may require medical
intervention to complete the birth process.
Psyche
refers to the psychological state or feelings that women bring into labor with
them
A woman who is relax, aware & participating in the birth process usually has
a shorter, less intense labor.
A woman who is fearful has high levels of adrenaline w/c slows uterine
contractions.
FORCEPS DELIVERY
FORCEPS
Are like metal tongs with two large spoon shaped edges that fit around the babys
head. They are inserted into the vagina to grip the babys head and speed up
delivery. This technique may be used if the babys heartbeat slows down during a
slow delivery of the head, or to ensure its safe delivery during a breech birth.
FORCEPS DELIVERY
VACUUM EXTRACTION
is a gentle alternative to forceps. A suction cup is placed over the top of babys
head and using an attached pump vacuum is created. This instrument then
becomes a handle which the doctor can use to rotate the head and pull while
pushing.
VACUUM EXTRACTION
VAGINAL BIRTH
The most common method of childbirth.
Women who give birth this way can breastfeed more easily, do not have to stay in
the hospital or clinic for very long and can avoid the risks involved with major
surgery, such as C-section.