Lie, Presentation, Station Flashcards by joseph dizon

Fetal lie

Fetal axis is perpendicular
Shoulder presentation

Transverse lie

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Fetal lie

Fetal and maternal axes cross at 45 degree angle
Unstable and becomes longitudinal or transverse lie during labor

Oblique lie

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Transverse lie predisposing factor

Uterus could be so lax

Multiparity

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Transverse lie predisposing factor

Placenta is located inferiorly when it should be located posteriorly

Placenta previa

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Transverse lie predisposing factor

Baby can move freely

Polyhydramios

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Transverse lie predisposing factor

Myxoma at lower uterine segment

Uterine anomalies

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Fetal presentation

Portion of the fetal body that is either foremost within the birth canal or in closest proximity to it

Presenting part

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Fetal presentation

Presenting part can be Cephalic or breech

Longitudinal lie

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Fetal presentation

The presenting part is the shoulder

Transverse lie

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Cephalic presentation

Common presentation
Head is flexed sharply so that the chin is in contact with the thorax

Vertex or occiput presentation

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Vertex presentation, what is the presenting part?

Occipital/posterior fontanelle

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Cephalic presentation

Uncommon
Fetal neck may be sharply extended so that the occiput and back come in contact

Face presentation

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Cephalic presentation

Partially flexed head
Anterior/large fontanelle/ Bergman is presented

Sinciput presentation

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Sinciput presentation if does not change can lead to

Dystopia

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Cephalic presentation

Partially extended head, can lead also to dystocia if does not change

Brow presentation

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Breech presentation

Incidence decrease in gestational age

25% at 28 wks AOG
17% at 30 wks AOG
11% at 32 wks AOG
3% at term

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Breech presentation

High incidence in

Hydrocephalus

Placenta previa

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Breech presentation

Thighs flexed, legs extended over anterior surfaces of the body

Frank breech presentation

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Frank presentation fetal attitude

Extended vertebral column

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Breech presentation

Thighs are flexed, legs flexed upon thighs
CS delivery unless preterm or small baby

Complete breech

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Complete breech problem?

Cord prolapse

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Breech presentation

One or both feet, or one both knees may be lowermost

Incomplete breech

Cord prolapse could be also the problem

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Fetal attitude or Posture

Characteristic posture

Back- convex
Head- flexed
Thighs- flexed over abdomen
Legs- bent at the knees
Arms- usually crossed over the thorax
Umbilical cord-

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Refers to the relationship of an arbitrarily chosen portion of the fetal presenting part to the right or left side of the birth canal

Fetal position

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Fetal position Determining points in various presentations

Vertex- occiput Face- chin (mentum) Breech - sacrum Shoulder - acromion

Fetal position Presenting parts may be in left or right position

LR occipital LR mental LR sacral

Fetal position Occipital fontanelle

Triangular shape

Fetal position Anterior fontanelle

Diamond shape

Fetal position Normal position

LOP

Fetal position At delivery

LOA

Fetal position Mentum anterior

Vaginal

Fetal position Mentum posterior

Of all vertex presentations 2/3 are in the

Left occiput position

Of all vertex presentations 1/3 are In the

Right occiput position

In shoulder presentation Portion of the fetus chosen for orientation with the maternal pelvis

Acromion (scapula) example | Right acromiodorsoposterior

In shoulder presentation Acromion or back of the fetus may be directed either

Posteriorly or anteriorly | Superiorly or inferiorly

In shoulder presentation Clinically important when deciding incision type for Caesarian section

Transverse lie, with back up or back down

Leopolds maneuvers Manuevers facing mothers face

1st, 2nd, 3rd

Leopolds maneuvers Facing mothers feet

4th manuever

Leopolds maneuvers Identification of which fetal pole (Cephalic or podalic)

1st maneuver or fundal grip

1st maneuver or fundal grip If there's large modular mass

Breech

1st maneuver or fundal grip If hard, round, mobile, and ballotable

Cephalic

Leopolds manuever Palms are placed on either side of the maternal abdomen

2nd M or umbilical grip

2nd M or umbilical grip If hard, convex and resistant

Back

2nd M or umbilical grip If numerous small, irregular, mobile parts

Fetal extremeties

Leopolds maneuver Grasping with the thumb and fingers of one hand the lower portion of the maternal abdomen just above the symphis pubis

3rd M or pawiks grip

3rd M or pawiks grip If movable mass will be felt, usually the head

Presenting part not engaged

3rd M or pawiks grip Indicative that the lower fetal pole is in the pelvis

Presenting part engaged

Leopolds manuever Tips of 3 fingers of each hand exerts deep pressure in the direction of the axis of the pelvic inlet

4th M or pelvic grip

3rd M or pawiks grip In Cephalic presentation, the shoulder is felt as a relatively fixed,

Knob like part

4th M or pelvic grip In Cephalic presentation, the part of the fetus that prevents the deep descent of the hand is

Cephalic prominence

4th M or pelvic grip If Cephalic prominence is felt on the same side of the fetal extremeties

Flexion attitude

4th M or pelvic grip If Cephalic prominence is felt on the same side of the fetal back

Extension attitude

Leopolds maneuver When the head has descended into the pelvis, the anterior shoulder may be differentiated readily by the

3rd manuever

Vaginal examination

Aralin mo, mahirap gawan ng brainscape

Aids fetal position identification, especially in obese women,

Sonography and radiography

Used for fetal head position determination during second stage labor

Transvaginal sonography

Vertex enters the pelvis with the sagittal suture lying in the transverse pelvic diameter

Occiput anterior presentation

The fetus enters the pelvis in the 40% of labor

LOT position

Fetus enters the pelvis in the 20% of labor

ROT position

Cardinal movement of labor

``` Engagement Descent Flexion Internal rotation Extension External rotation Expulsion ```

Engagement The greatest transverse diameter Is in an occiput presentation Passes through the pelvic inlet

Biparietal diameter

Engagement Fetal head may engage during the

Last few weeks of pregnancy or | After labor commencement

Engagement Fetal head is freely movable above the pelvic inlet at labor onset

Floating

Engagement Head usually enters the pelvic inlet either

Transversely or obliquely

Lateral deflection to a more anterior or posterior position in the pelvis

Asynclitism

Asynclitism Sagittal suture normally is deflected either

Posteriorly toward the promontory | Anteriorly toward the symphysis

Asynclitism Sagittal suture approaches the sacral promontory Anterior parietal bone presents itself to the examining fingers

Anterior Asynclitism

Asynclitism Sagittal suture lies close to the symphysis Posterior parietal bone will present

Posterior Asynclitism

Asynclitism Posterior ear may be easily palpated

Extreme posterior Asynclitism

Extreme posterior Asynclitism if severe, the condition is a common reason for

Cephalopelvic disproportion

1st requisite for birth

Descent

Descent Engagement may take before the onset of labor, and further descent may not follow until the onset of the second stage.

Nulliparas

Descent Descent usually begin with engagement

Multiparas

Descent in multi paras brought about by

Amniotic fluid pressure Direct pressure of the fundus Bearing down effort Extension of fetal body

Occurs when the descending head meets resistance,

Flexion

Resistance that cause flexion are from

Cervix Pelvic wall Pelvic floor

Flexion The chin is brought into more intimate contact with the

Fetal thorax

Flexion Shorter suboccipitobregmatic diameter is substituted for the

Longer occipito frontal diameter

This movement consist of turning of the head in such manner that the occiput gradually moves.

Internal rotation

Internal rotation From the original position

Anteriorly toward the symphysis pubis

Internal rotation This is less common

Posteriorly toward the hallow of the sacrum

Internal rotation Essential for completion of labor except when the fetus is

Unusually small

Internal rotation Completion varies

By the time the head reaches the pelvic floor Shortly after the head reaches the pelvic floor Rotation does not take place

Internal rotation When the head fails to turn until reaching the pelvic floor, it typically rotates during the

Next 1or2 contractions in multiparas | Next 3 to 5 contractions in nulls paras

Occurs when the sharply flexed head reaches the vulva after internal rotation

Extension

Extension Two forces come into play Exerted by the uterus Acts more posteriorly

1st force

Extension Two forces come into play Exerted by resistant pelvic floor and symphis Acts more anteriorly

2nd force

Extension The resultant vector is in the direction of the _________, thereby causing head extension

Vulvar opening

Extension The head is as the occiput, bregma, forehead, nose, mouth, and finally the chin pass successively over the

Anterior margin of the perineum

Extension Immediately after the delivery

Head drop downward | Chin lies over the maternal anus

The delivered head next undergoes restitution

External rotation

External rotation If rotates toward the left ischial tuberosity

Toward left

External rotation If rotates toward the right ischial tuberosity

Towards the right

External rotation Restitution of the head to the

Oblique position External rotation Transverse position

Almost immediately after external rotation

Expulsion

Expulsion Anterior shoulder Posterior shoulder

Under symphysis pubis | Distend the perineum

Occiput posterior presentation More common

ROP>LOP

Occiput posterior presentation Associated with

Narrow forepelvis | Anterior placentation

Occiput posterior presentation Internally rotate to the symphysis pubis

135 degree

Occiput posterior presentation To rotate promptly

Effective contractions Adequate head flexion Average fetal size

Occiput posterior presentation Incomplete rotation

Poor contractions Faulty head flexion Epidural analgesia

Occiput posterior presentation If rotation is incomplete

Transverse arrest

Occiput posterior presentation If no rotation toward the symphysis pubis takes place

Persistent occiput posterior

Fetal head shape changes Caput succedaneum Prolonged labors before complete cervical dilatation, the portion of the fetal scalp immediately over the cervical os become

Edematous

Fetal head shape changes Caput succedaneum More commonly, the Caput is formed when the head is in the

Lower portion of the birth canal And when Rigid vaginal outlet is encountered

Fetal head shape changes Molding Some molding develops before labor possibly related to

Braxton-hicks contraction

Fetal head shape changes Molding It is overlapping of the parietal bones, prevented by

Locking mechanism at the coronal and lamboidal connections

Fetal head shape changes Molding Results int the

Shortened suboccipitobregmatic And Lengthened mentovertical

Fetal head shape changes Molding Resolved within

Week following delivery

First stage of labor Preparatory division

Cervix dilate little Connective tissue components change Amniotomy is discouraged

First stage of labor Onset is when the mother perceives regular contraction

Latent phase

First stage of labor Latent phase usually ends once cervix dilate to

3-5 cm

First stage of labor Active phase Acceleration phase Phase of maximum slope

Dilatational division

First stage of labor Deceleration phase of cervical dilatation Mechanism of labor occurs Cardinal fetal movements

Pelvic division

First stage of labor Prolonged latent phase Nullipara

Exceeding 20 hours

First stage of labor Prolonged latent phase Multipara

Exceeding 14hours

First stage of labor Prolonged latent phase Factors that affect the duration

Excessive sedation | Unfavorable cervical condition

First stage of labor Prolonged latent phase Those with heavy sedation

85% enters active labor 10% false labor 5% requiring oxytocin

First stage of labor Active labor Nulliparas Rapid change in the slope of cervical dilatation between

3-5 cm

First stage of labor Active labor Nulliparas Dilatation plus contraction

Active labor

First stage of labor Active labor Nulliparas Mean

4.9 hours

First stage of labor Active labor Nulliparas Max

11.7 hours

First stage of labor Active labor Nulliparas Min

1.2-6.8cm/hr

First stage of labor Active labor Multiparas Min

1.5cm/hr

First stage of labor Active labor Descent begins in the later stage of active dilatation commencing at

7-8 cm in nulli and rapid after 8cm

First stage of labor | Active phase abnormalities

25% N | 15% M

First stage of labor Active phase abnormalities Slow rate of cervical dilatation or descent

Protraction N -

First stage of labor Active phase abnormalities Complete cessation of dilatation or descent

Arrest disorder 2 hours with no cervical dilatation - arrest of dilatation 1 hour without fetal descent - arrest of descent

First stage of labor Active phase abnormalities Average time from admission to complete dilatation

4. 8 hours N | 3. 2 hours M

First stage of labor Active phase abnormalities Lengthens active phase by 1 hour

Epidural analgesia Decreased the rate of cervical dilatation (1.6/hr - 1.4/hr)

First stage of labor Active phase abnormalities Normal labor

>6 hours to progress from 4-5 cm | > 3 hours to progress from 5-6 cm

First stage of labor Active phase abnormalities Lengthens 1st stage of labor by 30-60 minutes

Maternal obesity

First stage of labor Active phase abnormalities Increase labor by 45 minutes

Maternal fear

Second stage of labor

Begins with complete cervical dilatation and ends with fetal delivery

Second stage of labor Median duration

50minutes N | 20 minutes M

Second stage of labor If woman has higher parity how many expulsion efforts to complete the delivery

2-3

Second stage of labor May abnormally long

Contracted pelvis Large fetus Impaired impulsive efforts Conduction of sedation or analgesia

Second stage of labor Does not interfere

Increasing maternal body mass index

Third stage of labor

Begins with expulsion of fetus to delivery of placenta

Duration of labor N

9hours Upper limit was 18.5 hours

Duration of labor M

6 hours Upper limit was 13.5 hours

Fetal lie Fetal axis is parallel Cephalic/vertex or breech presentation

Longitudinal lie

Lie, Presentation, Station Flashcards

(143 cards)