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| Frank breech: In this position, the baby's buttocks are aimed at the birth canal with its legs sticking straight up in front of his or her body and the feet near the head. |
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| Is the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother. |
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Is the relation of the fetal body parts to one another.
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The biparietal diameter, which is about 9.25 cm at term, is the largest transverse diameter and an important indicator of fetal head size (Fig. 13-4, B). In a well-flexed cephalic presentation the biparietal diameter is the widest part of the head entering the pelvic inlet. Of the several anteroposterior diameters, the smallest and most critical one is the suboccipitobregmatic diameter (about 9.5 cm at term). When the fetal head is in complete flexion, this diameter allows it to pass through the true pelvis easily (see Fig. 13-4, A; Fig. 13-5, A). As the head is more extended, the anteroposterior diameter widens, and the head may not be able to enter the true pelvis (see Fig. 13-5, B and C).
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Station is the relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting part of the fetus through the birth canal. The placement of the presenting part is measured in centimeters above or below the ischial spines
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| Engagement is the term used to indicate that the largest transverse diameter of the presenting part (usually the biparietal diameter) has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0. It often occurs in the weeks just before labor begins in nulliparas and may occur before or during labor in multiparas. Engagement can be determined by abdominal or vaginal examination. |
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| The time from the beginning of one contraction to the beginning of the next. |
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| strength of contraction at its peak |
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Occurs during the first stage of labor.
Effacement is the process by which the cervix prepares for delivery. After the baby has engaged in the pelvis, it gradually drops closer to the cervix. The cervix will gradually soften, shorten and become thinner. You might hear phrases like “ripens” or “cervical thinning,” which refer to effacement.
Degree of effacement is expressed in percentages, from 0% to 100% (e.g., a cervix is 50% effaced)
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Dilation of the cervix is the enlargement or widening of the cervical opening and the cervical canal that occurs once labor has begun. The diameter of the cervix increases from less than 1 cm to full dilation (approximately 10 cm) to allow birth of a term fetus. When the cervix is fully dilated (and completely retracted), it can no longer be palpated. Full cervical dilation marks the end of the first stage of labor.
Dilation of the cervix occurs by the drawing upward of the musculofibrous components of the cervix caused by strong uterine contractions. Pressure exerted by the amniotic fluid while the membranes are intact or by the force applied by the presenting part can promote cervical dilation. Scarring of the cervix as a result of prior infection or surgery may slow cervical dilation. |
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| Stretch receptors in the posterior vagina cause release of endogenous oxytocin that triggers the maternal urge to bear down, or the Ferguson Reflex. |
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| refers to the sensation that a pregnant woman feels when the baby drops. This is the time when the presenting (lowermost) part of the fetus descends into the maternal pelvis. |
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• Lightening
• Return of urinary frequency
• Backache
• Stronger Braxton Hicks contractions
• Weight loss of 0.5 to 1.5 kg
• Surge of energy
• Increased vaginal discharge; bloody show
• Cervical ripening
• Possible rupture of membranes |
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The first stage of labor is divided into three phases: a latent phase, an active phase, and a transition phase. During the latent phase there is more progress in effacement of the cervix and little increase in descent. During the active and transition phases there is more rapid dilation of the cervix and increased rate of descent of the presenting part.
The first stage of labor lasts from the onset of regular uterine contractions to full dilation of the cervix.
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| Lasts from the time the cervix is fully dilated to the birth of the fetus. It is composed of two phases: the latent phase and the active pushing (descent) phase. During the latent phase the fetus continues to descend passively through the birth canal and rotate to an anterior position as a result of ongoing uterine contractions. The urge to bear down during this phase is not strong, and some women do not experience it at all. During the active pushing phase the woman has strong urges to bear down as the presenting part of the fetus descends and presses on the stretch receptors of the pelvic floor. |
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| Lasts from the birth of the fetus until the placenta is delivered. The placenta normally separates with the third or fourth strong uterine contraction after the infant has been born. After it has separated, the placenta can be delivered with the next uterine contraction. |
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| The fourth stage of labor arbitrarily lasts about 2 hours after delivery of the placenta. It is the period of immediate recovery when homeostasis is reestablished. The fourth stage of labor is also the time when parent-child bonding and attachment begins and breastfeeding is initiated. It is an important period of observation for complications such as abnormal bleeding. |
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| Four forces Descent depends on? |
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(1) pressure exerted by the amniotic fluid, (2) direct pressure exerted by the contracting fundus on the fetus, (3) force of the contraction of the maternal diaphragm and abdominal muscles in the second stage of labor, and (4) extension and straightening of the fetal body. The effects of these forces are modified by the size and shape of the maternal pelvic planes and the size of the fetal head and its capacity to mold. |
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| is when the baby's head is moving through the pelvis 'tipped' to one side. This is usually diagnosed by a vaginal examination in labour. However, asynclitism is rarely caused by the baby having his/her head tilted to one side and rarely a real problem. |
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Mechanism of Labor
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Mechanism of Labor
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Mechanism of Labor
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| Internal rotation to occipitoanterior (OA) position |
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Mechanism of Labor
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Mechanism of Labor
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| External rotation beginning (restitution) |
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Mechanism of Labor
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| Changes that stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth? |
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• Fetal lung fluid is cleared from the air passages as the infant passes through the birth canal during labor and (vaginal) birth.
• Fetal oxygen pressure (Po2) decreases.
• Arterial carbon dioxide pressure (Pco2) increases.
• Arterial pH decreases.
• Bicarbonate level decreases.
• Fetal respiratory movements decrease during labor. |
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| Occurs when the ascending vena cava and descending aorta are compressed. Occurs in the supine position. |
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| Fetal head formation is called? |
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1. Amenorrhea
2. Nausea and vomiting
3. Increased size and increased feeling of fullness in breasts
4. Pronounced nipples
5. Urinary frequency
6. Quickening: The first perception of fetal movement by the mother may occur the sixteenth to twentieth week of gestation.
7. Fatigue
8. Discoloration of the vaginal mucosa |
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1. Uterine enlargement
2. Hegar’s sign: Compressibility and softening of the lower uterine segment that occurs at about week 6
3. Goodell’s sign: Softening of the cervix that occurs at the beginning of the second month
4. Chadwick’s sign: Violet coloration of the mucous membranes of the cervix, vagina, and vulva that occurs at about week 4
5. Ballottement: Rebounding of the fetus against the examiner’s fingers on palpation
6. Braxton Hicks contractions (irregular painless contractions that may occur intermittently throughout pregnancy)
7. Positive pregnancy test for determination of the presence of human chorionic gonadotropin |
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| Positive signs (diagnostic) |
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1. Fetal heart rate detected by electronic device (Doppler transducer) at 10 to 12 weeks and by nonelectronic device (fetoscope) at 20 weeks of gestation
2. Active fetal movements palpable by examiner
3. Outline of fetus via radiography or ultrasonography |
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1. Portion of the fetus that enters the pelvic inlet first
2. Cephalic: Head first
a. Cephalic is the most common presentation.
b. Cephalic presentation has four variations—vertex, military, brow, and face.
3. Breech: Buttocks present first.
a. Delivery by cesarean section may be required, although vaginal birth is often possible.
b. Breech presentation has three variations—frank, full (complete), and footling
4. Shoulder
a. Fetus is in a transverse lie, or the arm, back, abdomen, or side could present.
b. If the fetus does not spontaneously rotate, or if it is impossible to turn the fetus manually, a cesarean section may need to be performed. |
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A. Description: Methods of palpation to determine presentation and position of the fetus and aid in location of fetal heart sounds
B. If the head is in the fundus, a hard, round, movable object is felt. The buttocks feel soft and have an irregular shape and are more difficult to move.
C. The fetus’s back, which is a smooth, hard surface, should be felt on one side of the abdomen.
D. Irregular knobs and lumps, which may be the hands, feet, elbows, and knees, are felt on the opposite side of the abdomen. |
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