Normal Labor 1 Flashcards
Talk about female pelvis
-Pelvic brim divides the pelvis into true pelvis and false pelvis that has no importance
-True pelvis has inlet cavity outlet.
Talk about inlet
- shape
- boundries
- diameters
- Oval
-anteriorly :upper border of Sp ,upper border of pubic bone, pubic tubercle
posteriorly, sacral promontory, ala of sacrum, sacroiliac joint
laterally, iliopectinal line with eminence, and upper border of superior pubic ramus. - (5)
1-AP or true conjugate diameter 11 cm
2-transverse diameter 13 cm
3-diagonal diameter 12.5 cm ( tested by pv diameter by 👉🏻 which is 10 , if the tight ~> contracted inlet length elsacram hwo ele meqrap) from the lower border of Sp, upper border of sacral promontory.
4 - right oblique diameter : right sacroiliac joint to left eminence 12cm
5-left oblique diameter :left sacroiliac joint to right eminence 12cm
•left shorter than right due to descending colon,
Talk about pelvic cavity
- shape
- boundries
- diameters
- round
-Anteriorly Sp
posteriorly Sacrum, with its concavity, giving it capacity
-AP diameter :12.5.
Transverse diameter :12.5
-Thus, it’s the plane of largest pelvic dimensions. -Thus, internal rotation occurs in this plane
Talk about pelvic outlet
- 2 triangles
- shape
- plane or segment
- boundries
- diameters
- Ant Sagittal Triangle with apex of SP
, POST Sagittal Triangle with Apex of OF tip of SACRUM or COCCYX
-segment as they are not on same level
- Wedge-shaped
-
•anteriorly :lower border of SP
•posteriorly :coccyx, but it moves backward in the second stage of labor, so tip of sacrum
•Laterally, space bet ischial spine and ischial tuberosity
•the floor :the anatomical outlet
•the roof : bispinous plane
- (5)
1-AP diameter from SP and tip of sacrum 13 cm.
2-Bituberous diameter bet ischial tuberosities 11cm ( tested by fist ( 8cm )
3- Bispinous diameter. 10.5 cm. The plane of least pelvic dimension Thus, it’s included ( tested by ✌🏻as it is less than 10 )
4- ANT sagittal diameter. 6-7 cm. Bet SP and The center of Bituberous
5-POST sagittal diameter. 7.5-10 cm. Bet Tip of sacrum or coccyx ,The center of Bituberous
Imp of ischial spine level
(8)
1- Level of levator ani in which it is attached to the ischial spine.
2-Level in which lies the external os of cervix and the vault of vagina ( prolapse if below )
3-Level of internal rotation.
4-Level of obstetric axis.
5-we feel the occiput at this level. To know that head is engaged.
6- Plane of least pelvis dimensions
7- Forceps can’t be used if the head is above this level.
8-Anesthesia of pudendal nerve block happens at this level.
What is obs axis
J-shaped moving of the head, it’s downward, backward till the level of scale spine, then it will be downward, forward.
Parts of fetal skull
1- Face from chin to root of nose and supraorbital ridge. ( mentum )
2-Brow from supraorbital ridge to the coronal suture ( no deno )
3- Vertex from coronal suture to the limboid suture and posterior fontanelle ( occupit )
لازززم احسسس الدينننوو
Diameters of fetus
1-Transverse
•Biparietal D 9.5 cm
• Bitemprol D8 cm
2- Vertical
•Suboccipital Bregmatic D :9.5 cm ,Fully Flexed
•Suboccipital Frontal : 10 cm ,Not Fully Flexed
•Occipital Frontal D : 11.5 cm ,Deflexed
•Submento bragmatic : 9.5 cm ,Fully Extended •
•Submento Vertical :11.5 cm ,Not Fully Extended
•Mento Vertical D: Midway Between Flexion and Extension, Brow Presentation Thus No VD ,13.5 cm
Terminology
1-Fetal presentation :the lowest part of fetus, entering the pelvis, first felt by vaginal examination
•maybe cephalic and it’s the most common, vertex 95%
face 0.5%
brow 0.1%
breech :sacrum with or without limbs, 3.5%, transverse :scapula with or without upper limbs 0,5%
2- Malpresentation ;Presenting part is anything other than vertex
3-Fetal lie : Relation of longitudinal axis of the fetus to the mother ,Longitudinal or transverse
4-Fetal attitude :Relation of the fetal parts to each other. Flexion or extension.
5-Fetal positio:Relation of denominator to which it’s right or left to the mother. Anterior or posterior ( Direct no rt or lt ,transverse no ant or post )
6- OA is more common than OP as the anterior convexoty of the ant part of the fetus fits in well with the concavity of the vertebral column of the mother
7- LOa > ROA, ROP >LOP.
8- OP is considered malposition, not malpresentation ( concave, convex , deflexed )
9- Asynclytism :The level of the parietal bone is not at the same level of the other one
•Ant : post parietal presentation.
•post : ant parietal presentation
•Asynclytism facilitates the entry of the head to the pelvis, as it brings the smallest diameter, sub-parieto-supraparietal diameter, 9 cm
•Asynclytism can happen in normal labor, corrected while the head is passing through the inlet before rotating,
10- Station 0 =Engagement
•Station - 1, - 2 :The head is above
•Station + 1, +2, + 3. Below the level of ischial spine.
11-Engagement : The entry of the widest transverse diameter of the presenting part, BPD, 9.5 cm in head ,Btd , 9.5 cm in breech.
•Its sign :felt at the level of ischial spine.
•2\5head is felt
•in PG, it happens at 36 week, due to potent uterine and abdominal muscles.
•In MG, it happens during first stage of labor, due to contraction and retraction of labor pain
• Causes of delayed engagement.
-Maternal
1-contracted pelvis
2-pelvic tumor
3-weak abdominal muscles
4-placenta previa
5- full rectum or UB
-Fetal
1-Macrosomia
2-prematurity
3- fetal head anomaly, hydrocephalus and anhydrocephalus
4-Polyhydromenous
5-multipregnancy
6-malpresentation
7- Op ( the commenst )
12 - Leopold maneuver :
-Fundal level
- Fundal grip
-Umbilical grip :Searching for back (Same level of head)
- 1st pelvic grip : Before engag
- 2ry pelvic grip :After engag
