Mechanism Of Labour ميسره

Question 1

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Whats the labour ?

Answer 1

Its series of changes of the attitude and position of the fetus to pass through the birth canal .

Question 2

Whats the labour describe ?

Answer 2

Its describe the vertex presentation and gynecois pelvis

Question 3

What’re the cardinal movement of the labour ?

Answer 3

1-engagement 
2-decent 
3-flexion
4-internal rotation 
5-extension 
6-restitution 
7-external rotation 
8-delivery

Question 4

Whats meant by engagement?

Answer 4

Its means the widest diameter of the presented part pass through pelvic inlet

Question 5

When the engagement of the nullipara and multipara?

Answer 5

Nullipara:
Before the delivery at 37 week

Multipara:
At the time of delivery

Question 6

How do we know that there is engagement?

Answer 6

If 2/5 of the head is palpable from the abdomen

Question 7

How the head enter the pelvic inlet ?

Answer 7

In transverse position (occipto- transverse)

Question 8

What’s the decend ?

Answer 8

Its has two stages

• 1st stage and the Passive phase of the 2nd stage of the labour the decending of the fetus as the result of uterine contraction
• 2nd active phase is by the voluntary abdominal muscle contraction of the mother valsava manuevaer

Question 9

Why there is flexion of the fetal head after the decent ?

Answer 9

Because of the resistance of the cervix, plevic wall ,pelvic floor so the fetus flex his head in order to shorter the presentation

Question 10

How the fetus flex his head ?

Answer 10

By approximate the chin to the fetus fetal thorax to shorten the presentation which sub occipito-pregamatic presentation

Question 11

When the fetus head makes internal rotation ?

Answer 11

If the head reached to the slopping gutter of levator ani

Question 12

How the internal rotation happen?

Answer 12

When the head reach the slopping gutter of the levator anii
The occiput move gradulaly from it origin towards the pubic symphsis
So that the sagittal suture lies AP to the pelvic outlet

Question 13

Whats happen if the engagement of the fetal haed was OP postion how the internal rotation will be ?

Answer 13

/الاحتمال الاول /If engagment was OP the interanl rotation will be OA
that means long internal rotation that prolong the time of delivery if the engagement was OP

/الاحتمال الثاني/But may the OP persists result in (face to pubes) delivery

Question 14

If the engagement were Op whats happen ?

Answer 14

Either the delivery is prolong and internal rotation makes it OA

Or delivery will be face to pubes so that the OP position is persisted

Question 15

When the fetal haed is extended?

Answer 15

When complete the internal rotation and the occiput is beneath the pubic symphysis and the bregma is near the lower scrum the well felex head extends

Question 16

How the extension of the fetal head happen ?

Answer 16

When internal rotation is completed and the occiput is beneath the pubic symphsis and the bregma is near the lower border of the sacrom the well flex head is extend now
And escape from the pubic symphsis and extend the vulva

Question 17

Whats the crowning of the head ?

Answer 17

Its the extension of the head

Question 18

What happen after extension ?

Answer 18

Further extension of the head
The occiput under the pubic symphsis act as fulcrum نقطه ارتكاز
And the bregma ,face and chin appear over post vaginal opening and perineal body

Question 19

What’s the meaning of restitutions?

Answer 19

When the occiput is Ant

The fetal head align with shoulder that enter in oblique position and skight rotation of the head 1/8 Of the circle

Question 20

When the restitutions happen ?

Answer 20

When the occiput is Ant and the head cross the perineum

Question 21

External rotation how it happen ?

Answer 21

• rotation of the shoulder in AP plane

- the occiput will rotates 1/8 in transverse position

Question 22

How the final stage of the movement of labour end ?

Answer 22

• restitutions and external rotation in AP position so that Ant shoulder under symphsis and delivered first by pulling the head up

Question 23

Select the correct answer for the following:
Engagement is defined as:- a. passage of sub-occipto pregmatic diameter through pelvic inlet. b. passage of occipito-frontal diameter through pelvic inlet. c. passage of biparital diameter through pelvic inlet. d. passage of sub-mento pregmatic through pelvic inlet.

Answer 23

C

Question 24

2: - Anterior Asynclitism mean:-
a. The saggital suture lie midway between symphsis pubis & promontory of sacrum.
b. The saggital suture lie close toward sacral promontory so that anterior parital bones will be the presenting bones in pelvic examination.
c. The saggital suture lie close to symphsis pubis so that posterior parital bones will be the presenting bones.
d. The sagital suture lie close to sacral promontory so that posterior parital bones will be the presenting bones.

Answer 24

B

Question 25

3. Descent movement
   a. It is usually precede the engagement movement.
   b. In primigravida further descent occur with onset of second stage of labor.
   c. In multigravida descent occur before the onset of labor.
   d. It can be caused by contraction of lower segment of uterus.

Answer 25

B

Question 26

4. In flexion movement:-
   a. The sub-occipito pregmatic diameter of fetal skull will change to occipito-frontal diameter.
   b. The occipto-frontal diameter will change to sub-mento –pregmatic diameter.
   c. The occipto-frontal diameter will change to sub-occipto-pregmatic diameter.
   d. The sub-mento-pregmatic diameter will change to sub-occipto-pregmatic diameter.

Answer 26

A

Question 27

5. Internal rotation:-
   a. Is the rotation of the occipit commonly toward sacral promontory so called occipito-posterior.
   b. Is the rotation of occipit commonly toward symphsis pubis so called occipito-anterior.
   c. It occur before engagment.
   d. Labor can be completed without internal rotation.

Answer 27

B

Question 28

6. By extension movement the first part of fetal head delivered is:-
   a. mentum.
   b. forehead.
   c. pregma.
   d. occipit

Answer 28

D

Question 29

7.External shoulder rotation:-

a. Is the rotation of shoulder from transverse plane to anterio-posterior plane.
b. It precede internal rotation.
c. It precede the restitution movement.
d. Is the rotation of shoulder from anterio-posterior plane to transverse plane.

Answer 29

A