Module 2 Feto-Pelvic Relationships Flashcards
Define fetal lie
Definition: Relationship of the long axis of the fetus to the long axis of the pregnant woman. The three possible lies are longitudinal, transverse, or oblique.
Broken Down: Which way the baby’s back is. Longitudinal=cephalic or breech (back is vertical: like this symbol | ). Transverse=like how an adult lays in bed-face up or down (back is horizontal: like this symbol -). Oblique is in between, neither vertical or horizontal (similar to this symbol / or ) where the shoulder is often the presenting part
Define Fetal Presentation
Definition: The part of the fetus that presents first to the maternal pelvis. The three possible presentations are cephalic, shoulder, and breech. Breech presentations are further subdivided based on presentation of the buttocks or feet.
Broken Down: What body part is attempting to deliver first (Head, breech, pelvis or shoulder)
Define Fetal attitude
Definition: Relation of fetal parts to each other. The basic attitudes are flexion and extension. The fetal head is flexed when the chin is close to the chest; it is extended when the occiput is closer to the cervical spine.
Broken down: flexion or extension of the head
Define Fetal position
Definition: Relationship of the denominator to the front, back, or sides of the maternal pelvis.
Broken Down: If the baby is facing maternal back or maternal abdomen (ex. OP=occiput posterior means the back of the head is at the maternal posterior-baby is facing the maternal abdomen aka. sunny side up)
Describe the four different cephalic presentations based on attitude.
Flexion: the chin is tucked to the chest
Neither flexion nor extension-usually called a (military attitude): the head is at a neutral position
Partial extension: the chin lifted up
Full extension: the chin is pointing completely up and the back of the head touching the baby’s back
**Understand how the position and attitude affect the presenting fetal diameter.
Explains the steps of Leopolds
Review Varney’s Midwifery p. 744 (section on determining the location of fetal back) and p.746 Figure 21A-4 in order to understand findings from the abdominal exam when the fetus is in a posterior position.
1) First Maneuver (Upper pole)
-Examiner faces woman’s head
-Palpate uterine fundus
-Determine what fetal part is at uterine fundus
2) Second Maneuver (Sides of maternal Abdomen)
-Examiner faces woman’s head
-Palpate with one hand on each side of Abdomen
-Palpate fetus between two hands
-Assess which side is spine and which extremities
3) Third Maneuver (Lower pole)
-Examiner faces woman’s feet
-Palpate just above Symphysis Pubis
-Palpate fetal presenting part between two hands
-Assess for Fetal Descent
4) Fourth Maneuver (Presenting part evaluation)
-Examiner faces woman’s head
-Apply downward pressure on uterine fundus
-Hold presenting part between index finger and thumb
-Assess for cephalic versus Breech Presentation
What is the difference between synclitism and asynclitism?
When a baby is asynclitic, the head is leaning toward the shoulder. The fetal head is tilted laterally toward the fetal shoulder, the biparietal diameter is not parallel to the planes of the pelvis.
Describe an assessment of anterior asynclitism?
Determination is based on which parietal bone is dominant. Anterior occurs when the anterior parietal bone becomes the lower-most presenting part, causing the sagittal suture of the fetal head will be palpable closer to the maternal sacral promontory.
Describe an assessment of posterior asynclitism?
Determination is based on which parietal bone is dominant. Posterior occurs when the posterior parietal bone becomes the lower-most presenting part, causing the sagittal suture of the fetal head will be palpable closer to the maternal symphysis pubis.
Explain the way in which asynclitism can assist or impede labor progress.
The fetal head usually enters the pelvic inlet with a moderate degree of posterior asynclitism and changes to anterior as it descends farther into the pelvis before internal rotation occurs. This occurs to take advantage of the roomiest part of the true pelvis.
Asynclitism can impede labor if it does not occur at the appropriate time.
What is cephalic prominence?
Which part of the fetal head you can feel with the fourth maneuver, shows you fetal attitude. Ex. when the head is flexed, the cephalic prominence is the forehead. With extension, the back of the head/occiput is the cephalic prominence
What is molding?
The change in the shape of the fetal head is a result of the soft skull bones overriding, overlapping one another because they are not yet completely fused so movement is possible at the location of the structures. Mild molding is a normal finding as the fetal head negotiates the pelvis. Significant molding could indicate the head not being engaged.
What is caput succedaneum?
The formation of an edematous swelling over the most dependent portion of the presenting fetal head. Pressuring around the presenting part by the cervical opening produces congestion and edema of the presenting fetal head. Significant caput could indicate the head not being engaged.
What is a cephalohematoma?
Bleeding beneath the periosteum
