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Y4R2 - Obstetrics I 🤰 > L3: Fetomaternal Relationships > Flashcards

L3: Fetomaternal Relationships Flashcards

1
Q

Definition of Lie

A

Relation of longitudinal axis of fetus to longitudinal axis of mother.

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2
Q

Types of Lie

A
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3
Q

Longitudinal Lie

A

Longitudinal axis of fetus is parallel to that of mother

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4
Q

Transverse lie

A

Longitudinal axis of fetus is perpendicular to that of mother

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5
Q

Oblique lie

A

Longitudinal axis of fetus forms acute angle è that of mother

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6
Q

Unstable lie

A

Not fixed for 24 hours

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7
Q

Def of Presentation

A
  • Part of fetus that occupies LUS, is firstly felt by vaginal examination, will descend 1st in natural birth canal & is 1st to be delivered.
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8
Q

Types of Presentation

A
  • Cephalic presentation (96%)
  • Breech presentation (3.5%)
  • Shoulder presentation (0.5%)
  • Complex (compound) presentation
  • Cord presentation
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9
Q

Cephalic presentation (96%)

A

Presenting part is head

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10
Q

Theories of Cephalic presentation

A

Gravitational theory:
- Head (heavy part) gravitates by its weight in lower part of uterus late in pregnancy.

Accommodation theory:
- As fetal body becomes larger in size in relation to head in late pregnancy, fetus is adapted to shape of uterus (head occupies the narrow LUS while breech occupies the wide fundus)

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11
Q

Types of Cephalic presentation

A
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12
Q

Breech presentation (3.5%)

A

Presenting part is podalic pole (buttocks ± LLs)

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13
Q

Shoulder presentation (0.5%)

A

Presenting part is shoulder

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14
Q

Complex (compound) presentation

A

≥ 1 fetal limb beside head or breech

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15
Q

Cord presentation

A

Umbilical cord presents below one of the above presentations.

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16
Q

Def of Position

A
  • On abdominal examination: Relation ( ) fetal back & anterior abdominal wall of mother.
  • On vaginal examination: Relation ( ) denominator & walls of maternal pelvis.
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17
Q

Def of Denominator

A

Bony landmark on presenting part used to denote position.

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18
Q

Examples of Denominator

A

1) Occiput: In vertex presentation.
2) Mentum (chin): In face presentation.
3) Frontum (frontal bone): In brow presentation.
4) Sacrum: In breech presentation.
5) Scapula: In shoulder presentation.

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19
Q

Types of Positions

A
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20
Q

Positions in vertex presentation

A
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21
Q

OA positions (80%) are more common than OP positions (20%), Why?

A

1) Concavity at front of fetus (due to flexion) fits into convexity of vertebral column at back of mother (lumbar lordosis).

2) Engaging diameter in OA positions is SOB (9.5 cm) while in OP positions it is OF (11.5 cm).

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22
Q

LOA position is more common than ROA position & ROP position is more common than LOP position, Why?

A
  • In the common positions, head engages in Rt
    oblique diameter of pelvic inlet which is slightly longer than the Lt one.
23
Q

Def of Attitude

A

Relation of fetal parts to each other.

24
Q

Typical Fetal Attitude

A
  • fetal attitude: Generalized flexion è head bent in front of chest, arms & legs are folded in front of body & back is slightly curved.
25
Q

Types of fetal head Attitude

A

1) Complete flexion: Chin approaches chest wall (the usual attitude).

2) Deflexion.

3) Military position: Midway ( ) flexion & extension.

4) Partial extension.

5) Complete extension: Occiput approaches back.

26
Q

Def of Synclitism

A
  • Presence of sagittal suture midway ( ) symphysis pubis & promontory of sacrum.
27
Q

Def of Asynclitism

A
  • Lateral inclination of fetal head making sagittal suture lies nearer to either promontory of sacrum or symphysis pubis & parietal bones not lie at the same
    horizontal level (one parietal bone is lower than the other).
28
Q

Incidence of Asynclitism

A
  • Occurs when true conjugate diameter is shortened (as in contracted flat pelvis).
  • Mild degree of asynclitism may occur in normal labor.
29
Q

Significance of Asynclitism

A
  • ↓↓ engaging transverse diameter of fetal head to allow its passage through pelvis [supraparietal subparietal diameter (9 cm) enters pelvis instead of BPD (9.5 cm)].
30
Q

Types of Asynclitism

A
31
Q
  • Naegele’s obliquity
  • Posterior asynclitism
  • anterior parietal bone presentation
A
32
Q
  • Litzmann’s obliquity
  • anterior asynclitism
  • posterior parietal bone presentation
A
33
Q

Def of Engagement

A
  • Passage of largest transverse diameter of presenting part (BPD in vertex presentation) through plane of pelvic inlet
  • Selection of transverse diameter is done to eliminate effect of change in fetal head attitude which will change the engaging longitudinal diameter).
34
Q

Time of Engagement

A
35
Q

Time of Engagement

  • Primigravida
A
  • Usually occurs in last 3-4 weeks of pregnancy due to strong abdominal wall & uterine muscles).
36
Q

Time of Engagement

  • Multigravida
A
  • May occur normally at start of 2nd stage of labor.
37
Q

Significance of Engagement

A

Excludes disproportion ( ) presenting part & pelvic inlet.

38
Q

Dx of Engagement

A
  • Hx
  • Ex (Abdominal & Vaginal)
  • INVx
39
Q

Dx of Engagement

  • Hx
A
  • Disappearance of upper abdominal pressure symptoms & appearance of lower abdominal & pelvic
    pressure symptoms.
40
Q

Dx of Engagement

  • Abdominal Ex
A
41
Q

Abdominal Ex in Dx of Engagement

A
42
Q

Abdominal Ex in Dx of Engagement

  • 1st Pelvic grip
A

Failure to grasp presenting part.

43
Q

Abdominal Ex in Dx of Engagement

  • 2nd Pelvic Grip
A

Fingers of both hands are divergent & hands can’t be insinuated below head

44
Q

Abdominal Ex in Dx of Engagement

  • Role of fifths (Crichton’s technique)
A
45
Q

Vaginal Ex in Dx of Engagement

A
46
Q

Def of Station of presenting part in pelvis (Delee stations)

A

It is the relation of leading point of presenting part to ischial spines.

47
Q

Ischial spines are midway …..

A

( ) pelvic inlet & outlet.

48
Q

Station of presenting part in pelvis (Delee stations)

  • Description
A
49
Q

INVx to Dx Engagement

A

Ultrasound or X-ray.

50
Q

Causes of non engagement of head in last 3-4 weeks of pregnancy in primigravida

A
51
Q

Causes of non engagement of head in last 3-4 weeks of pregnancy in primigravida

  • Faults in Power
A

a) Atony of abdominal wall.
b) Tonic LUS.

52
Q

Causes of non engagement of head in last 3-4 weeks of pregnancy in primigravida

  • fauls in Passages
A

a) Placental previa.
b) Contracted pelvis.
c) Pelvic bone tumors.
d) Pelvic mass.
e) Rigid cervix.
f) Tough vagina.
g) Full bladder & rectum.

53
Q

Causes of non engagement of head in last 3-4 weeks of pregnancy in primigravida

  • Faults in Passengers
A

a) Malpresentation & malposition.
b) Short cord or cord around fetal neck.
c) Polyhydramnios or oligohydramnios.
d) Macrosomia.
e) Hydrocephalus.
f) Multifetal pregnancy.

Y4R2 - Obstetrics I 🤰 (33 decks)

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