Escolar Documentos
Profissional Documentos
Cultura Documentos
DR. SALWA NEYAZI CONSULTANT OBSTETRICIAN GYNECOLOGIST PEDIATRIC & ADOLESCENT GYNECOLOGIST
. ' "
'
I
! 1 \
1 1
A B
i i F
c
D
(A) vertex
(B) sinciput
(C) brow
(D) face
Longitudinal lie. Cephalic presentation. Differences in attitude of fetal body, Note changes in fetal attitude in relation to fetal vertex as the fetal head becomes less flexed.
I I
Longitudinal presentation.
lie.
Frank
breech
POSITION
The relation of an arbitrary chosen point of the fetal presenting part to the Rt or Lt side of the maternal birth canal The chosen point Vertex presentation occiput Face presentation mentum Breech presentation Sacrum Each presentation has two positions Rt or Lt Each position has 3 varieties : Ant, transverse, post
OA
ROA ROT
ROP OP
LOA LOT
LOP
~ ' t J
3 ~
S f
a !
w
C c
h t
p ( f i t t b f e
c
a l t a
Lt mento-ant
Rt mento-ant
Rt mento-post
Longitudinal lie. Face presentation. Left and right anterior and ri posterior positions.
Transverse lie. Right acromiodorsoposterior position (RADP). The shoulder of the fetus is to the mother's right, and the back is posterior.
Normal synclitism
3-FLEXION
The descending head meets resistance of pelvic floor, Cx & walls of the pelvis flexion The shorter suboccipito-begmatic is substituted for the longer occipito-frontal
Lever action producing ftexion of the head; conversion from occipitofrontal to suboccipitobregmatic diameter typically reduces the anteroposterior diameter from nearly 12- to 9.5 cm.
c
D
Four degrees of head flexion. Indicated by the solid line the occipitomental diameter; the broken line connects the center of the anterior fontanel with posterior fontanel: A. Flexion poor. B. Flexion moderate. C. Flexion advanced. D. Flexion complete. Note that with flexion complete the chin is on the chest, and the suboccipitobregmatic diameter, the shortest anteroposterior diameter of the fetal head, is passing through the pelvic inlet.
4-INTERNAL ROTATION
Turning of the head from the OT position anteriorly towards the symphysis pubis ie. Occiput moves from transverse to ant 45 Less commonly OT posteriorly towards the sacrum 135
It is not accomplished till the head has reached the spines The levator ani muscles form a V shaped sling that tend to rotate the vertex anteriorly It is completed by the time the head reaches the pelvic floor 2/3 or shortly after
EXTENSION
When the flexed head reaches the vulva it undergoes extension the base of the occiput will be in direct contact with the inferior margin of the symphysis pubis Crowning the largest diameter of the fetal head is encircled by the vulvar ring The head is born by further extension as the occiput, bregma, forehead, nose, mouth & chin pass successively over the perineum
Cardinal movements in the mechanism of labor and delivery, left occiput anterior position.
3 0 2
2.Engagement;descent, flexion
4. Complete extension
rotation,
beginning
3 0 4
F t l v b
a f s
Mechanism of labor for the left occiput transverse position, lateral view. Posterior asynclitism (A) at the pelvic brim followed by lateral flexion, resulting in anterior asynclitism (B) after engagement, further descent (C), rotation, and extension (D).
, .
, 0
occiput