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Fetus: cardinal movements of fetus
"Don't Forget I Enjoy Really Expensive Equipment" |
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Descent
Flexion
Interal rotation
Extension
Restitution
External rotation
Expulsion |
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| Relationship of fetal parts to each other. The basic attitudes are flexion and extension. The fetal head is in flexion when the chin approaches the chest and in extension when the occiput nears the back. The typical fetal attitude in the uterus is flexion, with the head bent in front of the chest, the arms and legs folded in front of the body, and the back curved forward slightly. |
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| Variable decelerations are associated with cord compression. (V and C) Early decelerations are associated with head compression. This is generally a benign event. (E and H) Accelerations are associated with oxygenation – which explains why they’re generally a good prognostic factor. (A and O) Late accelerations are associated with placental insufficiency. (L and P) Variable decelerations are the most common of the decelerations but also the most complex. The exact shape of the deceleration is determined by whether the uterine artery or vein is occluded first – but the important thing to remember is that it’s caused by compression of the umbilical cord. Unlike early and late decelerations, variable decelerations are not gradual. This works to your advantage, as their relative abruptness makes them easy to pick out in a monitoring strip. The “early” in “early deceleration” refers to the lowest point of the deceleration occurring at the same time as the peak of the contraction. They are a result of increased vagal tone secondary to head compression and are generally benign when they occur during the 1st or 2nd stage of labor – but they can be a sign of cephalopelvic disproportion if they persist. The “Late” in “Late decelerations” refers to the lowest point of the deceleration occurring after the peak of the contraction. Maternal contractions constrict the placental blood supply, thereby limiting the fetus’ blood supply to what’s already stored in the placental reserve. In the case of uteroplacental insufficiency, this lack of oxygen results in a deceleration which occurs as a result of (i.e. after) the contraction. - See more at: http://tr-i-life.tumblr.com/post/22308196642/another-great-mnemonic-for-ob-is-veal-chop-the#sthash.AZFusrHe.dpuf |
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asynclitism means the head is tilted toward the shoulder, similar to the position of a person holding a telephone between their head and shoulder.
In anterior asynclitism, the anterior parietal bone (meaning the parietal bone that is in the anterior part of the pelvis) descends first and the sagittal suture is closest to the sacrum. In posterior asynclitism, the posterior parietal bone (again meaning the parietal bone that is in the posterior part of the pelvis) descends first and the sagittal suture is closest to the symphysis pubis.
If the fetal head is occiput transverse (OT), and the fetal head is synclitic, the finding on vaginal exam would be a sagittal suture that is equidistant to the symphysis pubis and sacrum, or right in the middle. If the head is asynclitic the sagittal suture is closer to either the symphysis pubis or the sacrum.
The presenting diameter is smaller when the head is asynclitic, thus this may allow for engagement with a smaller pelvis or larger head. Asynclitism is not abnormal, however if the head remains asynclitic as it continues to descend in the pelvis internal rotation may be prevented. |
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| The relationship of the fetal parts to each other. Oxorn makes the important distinction between flexion and extension, and Varney discusses how a curved or arched back results from a flexed or extended head, respectively, another important point. Attitude is the posture of the fetus, specifically the degree of flexion or extension of the head. |
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The part of the fetus that lies over the pelvic inlet. There are three possibilities—cephalic or head first, breech or pelvis first, and shoulder.
Presenting Part: The most dependent part of the fetus. This is the part of the fetus that you feel first when doing a vaginal examination. With a cephalic presentation, the presenting part can be vertex (two different aspects), brow, or face. |
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| The area of the occipital bone, “behind” the posterior fontanelle. This is the back of the fetal head. |
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| The area between the posterior and anterior fontanelles. This is the top of the fetal head. |
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| The area between the anterior fontanelle and the orbital ridges (upper margin of eye sockets). This is the brow or front of the fetal head. |
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