Labour

Labour Normal

Questions

Maternal pelvis

Pelvic assessment :

Process of pelvic assessment? 7 When is the assessment done? 4 types of pelvis? Android pelvis characteristics? 6

transverse diameter = ileopectineal line farthest point

sarco iliac to iliopuboc eminense = oblique

Fetus skull

beparietal = between parietal eminsnese

bi temporal = furthest point of the coronal suture

bimastoid = 7cm smallest diamater that cannot be compressed further.

Normal atutude of the fetus is that of flexion

Molding = compression of the presenting diameter and elongation of the perpendicular diameter

Bones are the parietal bones and grades examined during pv

Mechanism of normal labour

mechanism in normal

Can only determine fetal position after complete per abdominal and per vaginal. Per abdominal can give its LO but the last letter need to do per vaginal and feel for the parietal suture and bregma.

can palpate when membranes intact or when broken. When broken much easier to palpate....must not palpate when the membranes are tensed as in uterine contraction!!

Cardinal steps of labour

To determine whether its sinciput or occiput got to compair with relation to the side where the back is felt...thats occiput!

If pelvic brim thin, then engagement wont happen easily

2 reasons why its the occiput that internally rotates 1. the muscles of the levator ani favours this 2. its the occiput that lands on the pelvic floor first

Then occiput lies behind pubic symphysis

the shoulder after 1/8 rotation lies in the oblique diameter And then the head is delivered by extension, but still 1/8 tension maintained

Then the tension is relieved

But the the shoulders internally rotate to come behind the pubic symphysis

which is seen as enternal rotation of the head to lie in the same starting LOT set up

HEad rotates with the external rotation of the shoulder..same same and not relative

Occiput always come to lie behin d pubic symphysis irregardless of fetal position

So internal rotation is a very important step

If ROT lie then at the end will also return to the ROT head position.

For other positions - can work out the same logic...eg LOA ...similar movement so that when delivery it delivers the same way - but keep in mind that neck can only take 1/8 tension. not more.

Labour in ROP position

ROP :

Intro? why right more than left? Malpositions freqnecy in primi gravida and multipara? Causes of ROP? Malposition vs malpresetation Presentation in ROP? Causes of ROP?

Clinical diagnosis of ROP position? 3 parts? Where FHS heard in other positions?

Mechanism of labour in ROP position? Frequencies? Favourable outcomes in? Usual mechanisms? When unfavourabke outcomes? 4

3 unfavourable outcomes?

outcomes in delivery? when intrumental and when ceasarian?

3rd out come? Delivery only in? How delivery? Adverse effect?