Mechanism of labour

Question 1

What is mechanism of labour for baby in Anterior position

Answer 1

Descent
flexion (enter brim transverse 11cm)
internal rotation (12cm)
crowning
extension (Anterior posterior diameter) - sinciput, face and chin sweep perineum
restitution (head returns to correct alignment with shoulders )
shoulders internally rotate (to fit AP diameter of outlet)
head externally rotates (head move stowards woman’s thigh)
shoulder released (usually anterior)
laternal flexion

Question 2

describe the two fontanelles

what are they?
location / size / shape / when do they close

Answer 2

space / soft spots on head
where sutures join

anterior fontanelle (bregma)- smaller, diamond, closes last (8mths). Joins frontal + parietal bone
posterior fontanelle (lambda)- larger / triangle, closes first (2mths). Joins Occiput bone and parietal bone

Question 3

what are sutures?
where are they?

Answer 3

elastic tissue that hold together bones of head - enabling spaces / moudability

Sagittal suture (along vertex)
coronal suture (coming off bregmatic fontanelle)

Question 4

What are the sections of the head, in relation to fontanelles

Answer 4

occiput (under posterior fontanelle)
vertex (between anterior and posterior fontanelle)
Sinciput/ brow (between anterior fontanelle and Occipitofrontal diameter)
Glabella (between eye and nose)
face (sit under occipitofrontal diameter)
Mentum (chin)

Question 5

where is glabella

Answer 5

skin between eyebrows and nose

Question 6

what is definition of presentation

Answer 6

the part of the baby in the pelvic brim (cephalic/ breech / shoulder )

Question 7

what is definition of presenting part (list for each presentation)

Answer 7

part of body that lies closest to cervix

(cephalic- vertex, brow, face)
(breech- (frank- legs extended), complete (feet tucked to bottom), footling)

Question 8

what is definition of “lie”

Answer 8

relationship of mum’s back to baby

longittudinal
transverse
obligue

Question 9

what is definition of attitude

Answer 9

Relationship of fetal head and limbs to its body

fully flexed / deflexed/ partially or completely extended

Question 10

what is definition of denominater

Answer 10

landmark on presenting part, describes degree of rotation

vertex- occiput
buttock- sacrum
face- metum

Question 11

what is definition of position

Answer 11

relationship between denominator (occiput / sacrum) nad pelvic brim (left / right / anterior / posterior)

Question 12

Describe vertex presenting part

what is denominator
what are types of flexion and circumferences?

Answer 12

denominator- occiput

Fully flexed Vertex -Suboccipital bregmatic diameter (9.5)
partially deflexed- suboccipital frontal (10.5)
deflexed vertex- occipitalfrontal (11.5)

Question 13

Describe face presentation

what is denominator

what are types of flexion and circumferences?

what position does menum need to be in, to birth

Answer 13

denominator- mentum

Extended- submentum bregmatic 9.5
partially extended- submentum vertical 10.5

mentum needs to be anterior (if posterior, it gets stuck at sacrum)

Question 14

Describe brow presentation

what is denominator

what is diameter

Answer 14

denominator- glabella

mentovertical - 13.5cm

Question 15

what is biparietal diameter?

Answer 15

diameter between parietal bones (cephalic presentation)
9.5cm

Question 16

what is bisacral diameter

Answer 16

diameter between sacral bones (breech presentation)
9.5

Question 17

What is OP position / signs on palpation + VE

Answer 17

definition-
baby’s occiput is posterior
back to back

Signs
spine felt at flank / not palpable
mum feels movements on both sides
dip under umbilicus
Posterior fontanelle (triangle) in bottom quadrant
may have irregular cx

Question 18

mechanism of labour - OP (long rotation)

Question 19

Station
Definition and classification

Answer 19

Relationship to presenting part and ischial spines

+1 = going past spines (below spines)
-1 = above spines

Question 20

Descent
Definition and how to classify

Answer 20

How much of baby’s head is palpable (above brim)

5/5 = all palpable
0/5 = not in brim at all

Question 21

what are 3 scenarios for baby in posterior position in labour

Answer 21

long rotation
- flexed head can rotate full 135 degrees to get into anterior position

short rotation
- head is deflexed, so can’t rotate fully. completes short rotation and born face to pubes (12.5cm - occipito mento)

deep transverse arrest-
head attempts long rotation but arrests at level of spines

Question 23

What is bracht manouvre
indication

Answer 23

indication- continued progree
‘hands off’!

Question 24

Louwen manouvre
indication
what does it involve

Answer 24

when
descent halts before nipple line, and body is SACRO OBLIQUE ( instead of sacro anterior)

manouvre
mum’s hands circle mody
turn baby 180 towards direction it came, then back 90
then wait

Question 25

LOVSET Manouvre
indication

manouvre:

Answer 25

indication
progress halts at umbilicus - due to upward displacement of arms (e.g. shoulder caught under pubic symphysis)

manouvre
lift body anteriorly (= lateral flexion)
rotate trunk 180 (keeping back anterior)- release posterior shoulder
repeat - rotate trunk reversely 190 degrees, to release anterior shoulder)
leave baby to hang

Question 26

kristerllir manouvre

indication
manouvre

Answer 26

progress halts at umbilicus- arms out

manouvre- apply suprapubic pressure to maintain occipital flexion

Question 27

mauriceau smellie manouvre
indication

Answer 27

indication- progress halts at umbilicus
manouvre-
fingers pressing down on chin
other hand- push down on back, finger pushing down on occiput ot keep flexion

Question 28

shoulder press

indication- head not releasing, as it’s not flexed

Answer 28

press down on shouders
can also do rock and roll

Question 29

Describe 3 Types of Breech presentating parts

Answer 29

frank- legs extended, pelvis flexed. presenting part is buttocks.

complete- pelvis and knees flexed. presnting part is buttocks (feet are near buttocks)

incomplete- either 1 or both hips + knees flexed= either feet or knee is below hte buttock.

Question 30

if mentum is denominator, what is presentation

Answer 30

face