Easy Points: Physiology OB - Mechanism of Labor, Fetal Lie, Presentation, Attitude and Position

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Easy Points: Physiology OB - Mechanism of Labor, Fetal Lie, Presentation, Attitude and Position
2013-11-27 11:18:10
physiology ob labor olfu2016 fetal lie presentation
Physiology OB: Labor
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  1. Period from the onset of regular uterine contractions until expulsion of the placenta
  2. Characteristics of labor
    Toil, trouble, suffering, bodily exertion, painful
  3. amnestic effect after given medications to relieve pain like Medazolam/ Dormicum
    Twilight effect
  4. Factors that affect labor
    •  Size of baby
    •  Size of pelvis
    •  Presentation
  5. Relation of the fetal long axis to that of the mother
    Fetal lie
  6. Predisposing factors for transverse lie
    • Multiparity
    • Placenta previa
    • Hydramnios
    • Uterine anomalies
  7. Which presentation?
    Usual presentation
    Head is flexed sharply so that the chin is in contact w/ the thorax
    Occipital/ Posterior fontanel is presenting part on IE
    Vertex or occiput presentation
  8. Which presentation?
    fetal neck may be sharply extended so that the occiput & back come in contact
    Fully extended 
    Look for 2 malar eminences w/ the opening w/c will create a triangle
    Palpate for the ischial tuberosity w/c will create a straight line
    Face presentation
  9. Which presentation?
    partially flexed head
    the anterior/large fontanel, or bregma, presenting
    can lead to dystocia if does not change to vertex or face presentation
    Sinciput presentation
  10. Which presentation?
    partially extended
    can lead to dystocia if it does not change to vertex or face presentation
    Brow presentation
  11. Which presentation?
    thighs flexed, legs extended over anterior surfaces of the body
    Only one among the breech presentations that has room for vaginal delivery unless preterm
    FETAL ATTITUDE: extended vertebral column
    Frank breech presentation
  12. Which presentation?
    thighs are flexed, legs flexed upon thighs
    CS delivery unless preterm or small baby
    Problem: cord prolapse
    Complete breech
  13. Which presentation??
    one or both feet, or one or both knees may be lowermost
    CS delivery unless preterm or small baby Problem: cord prolapse
    Incomplete breech
  14. characteristic postureassumed by the fetus
    Attitude or habitus
  15. Characteristic posture of the fetus in the uterus
    • 1. back becomes markedly convexed
    • 2. head is sharply flexed so that the chin isalmost in contact w/ the chest
    • 3. thighs are flexed over the abdomen
    • 4. legs are bent at the knees
    • 5. arches of the feet rest upon the anteriorsurface of the leg
    • 6. arms are usually crossed over the thorax orbecome parallel to the sides
    • 7. umbilical cord lies in the space b/w them &the lower extremities
  16. Refers to the relationship of an arbitrarily chosenportion of the fetal presentating part to the rightor left side of the birth canal
    fetal position
  17. Shape of occipital fontanel
  18. Shape of anterior fontanel
  19. Determining point of vertex presentation
    fetal occiput
  20. Determining point of face presentation
    Chin (mentum)
  21. Determining point of breech presentation
  22. Determining point of shoulder presentation
  23. Which maneuver of Leopold's maneuver?
    Identification of which fetal pole - cephalicor podalic - occupies the uterine fundus BREECH: large, nodular mass CEPHALIC: hard, round, mobile &ballottable
    1st/Fundal grip
  24. Which maneuver of Leopold's maneuver?
    Palms are placed on either side of thematernal abdomen Gentle but deep pressure is exerted BACK: hard, convex & resistant Orientation of the fetus can bedetermined if back is directedanteriorly, transversely, or posteriorly FETAL EXTREMITIES: numerous small,irregular, mobile parts
    2nd/Umbilical grip
  25. Which maneuver of Leopold's maneuver?
    Grasping w/ the thumb & fingers of onehand the lower portion of the maternalabdomen just above the symphysis pubis PRESENTING PART NOT ENGAGED:movable mass will be felt, usually the head PRESENTING PART ENGAGED: Indicative that the lower fetal pole is inthe pelvis If cephalic presentation, the shoulder isfelt as a relatively fixed, knob like part
    3rd/Pawlik's grip
  26. Which maneuver of Leopold's maneuver?
    Examiner faces the mother’s feet Tips of 3 fingers of each hand exerts deeppressure in the direction of the axis of thepelvic inlet One hand descends further than theother In cephalic presentation, the part of thefetus that prevents the deep descent ofthe hand is the CEPHALICPROMINENCE FLEXION ATTITUDE: if cephalicprominence is felt on the same side ofthe fetal extremities
    4th/Pelvic maneuver
  27. Sagittal suture frequently is deflected either posteriorly toward the promontory or anteriorly toward the symphisis
    Baby will have a harder time to navigate across pelvis
  28. 1st requisite for birth
    Brought about by:
     Pressure of amniotic fluid
     Pressure of fundus on the breech
     Bearing down efforts of mother
     Extension & straightening of fetal body
  29. Prolonged labor before complete cervical dilatation, the portion
    Caput Succedaneum
  30. Overlapping of sutures
    Not common