MATERNAL CHILD NURSING
Care of Mother, Child, Adolescent (Well-Client) Theory
Cebu Doctors’ University
2F: OBSTETRIC ANATOMY
BONES OF THE SKELETON
- Support body weight
- Act as attachment points for muscle
Focus:
- Female pelvis
Ø Supports major load of the pregnant
uterus
- Fetal skull
Ø Passes through the woman’s pelvis
when she gave birth
Importance of knowing the landmarks in the
anatomy of the female pelvis and the fetal skull
- Knowing these landmarks will enable you
to estimate the progress of labor by
identifying changes in their relative
position as the baby passes down the birth
canal
CONCEPTUAL FRAMEWORK
- We have a mother who is pregnant, if the
mother is going through her regular prenatal
checkups, performing yoga exercises,
eating a lot of healthy foods (fruits and
vegetables), a good support system, a good
psychological development, and the mother
is aware of everything that is good for her
baby and is educated enough à high level
wellness
- For a mother who has vices all throughout
her pregnancy (drinking, smoking,) has a
bad psychological development not just for
pregnancy but towards other people, eats a
lot of sugar or unnecessary food intake
(sugar is prohibited if there is too much
consumption of it à gestational diabetes)
and the mother is also stressed all
throughout her pregnancy à signs and
MABALOT, Christianne Jacob O.
BSN2-E
NCM 107 Theory
October 19, 2021
symptoms of disability. If it is not treated, it
could lead to premature death, not just for
the mother but also for the baby.
LABOR
- A series of events by which uterine
contractions and abdominal pressure expel
a fetus and placenta from the uterus
- Process of delivering ab aby and the
placenta, membranes and umbilical cord
from the uterus to the vagina to the outside
world
- During the first stage of labor (dilatation),
the cervix dilates fully to a diameter of about
10 cm that is equals to inches.
First stage of labor divided into 2 phases
- Latent phase
- Active phase
THEORIES OF LABOR
- Normally it begins between 37 and 42
weeks
- Premature – If the labor can begin fetus is
mature
- Post term labor – If labor occurs or is
delayed until fetus and placenta have both
passed beyond the optimal point for birth
- There are a lot of mechanisms that could
trigger onset of labor.
- The current belief that focus on the
combination of occurrences as responsible
for initiating labor
o Uterine stretching caused by
hormones or increased/decreased
in hormones that could affect the
uterine wall
o Changes in estrogen and
progesterone balance
o Oxytocin stimulation
o Cervical pressure
o Prostaglandin production by the
fetus
o Aging of the placenta
o Increased fetal cortisol
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 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

COMPONENTS OF LABOR FOUR JOINTS

- 4 important components that must work
together for labor to progress manually

1. Passage – refers to the maternal pelvis

itself. A maternal pelvis should be suitable
to the passenger
2. Passenger – refers to fetus
3. Power – amount of push the mother will
exert during the delivery
4. Psyche – psychological development of
1. Symphysis pubis
the mom is very important all throughout
2. Right sacroiliac joint
her pregnancy and it could refer to the
3. Left sacroiliac joint
past experiences a mother had prior to
4. Sacrococcygeal joint
pregnancy
Important during labor and delivery
These provide stability of the pelvis
These four components of labor, if one is
altered, the outcome of labor can be adversely
affected PARTS AND FUNCTIONS
- Innominate bone – ilium (upper lateral
PASSAGE portion) and ischium (inferior portion) and
- Refers to the route that the fetus must travel pubis
from the uterus through the cervix and - Hip – crest of the ilium
vagina to the external perineum - Ischial tuberosities – important markers
- Focus: used to determine lower pelvic width
o Shape of pelvis - Ischial spines – mark the midpoint of pelvis
o Bony structures
o Pelvic diameter PELVIC DIVISIONS
o Soft tissues
PELVIS
- In an obstetrical standpoint, it is useful ton
consider the bony pelvis as a whole rather
than a separated part
- A bony ring formed by four united bones
o Two innominate (flaring hip) bones
o Coccyx - False pelvis
o Sacrum - True pelvis
o Serves both to support and protect - The bony line – brim of the pelvis
pelvic organs
o They also form four joints False pelvis
- Found in the superior half of pelvis
- Upper portion of pelvic inlet and supports
internal organs and upper body

MABALOT, Christianne Jacob O. 2

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

DIFFERENCE OF A MALE AND FEMALE PELVIS

True pelvis

Male Female
Arc – 70 degrees or Arc – 90-100 degrees,
- Inferior half acute angle obtuse
- Includes the pelvic inlet, outlet, and cavity Much narrower Broader
- Chief of concern of obstetrician since it Much longer Larger
forms the canal through which fetus has to Subarc
pass, called also pelvic brim
- Pelvic inlet – entrance to the true pelvis,
called also pelvic brim TYPES OF PELVIS
- Pelvic outlet – inferior portion of the fetus 1. Gynecoid
- Pelvic cavity – space between the inlet and 2. Android
outlet 3. Anthropoid
4. Platypelloid

Gynecoid-shaped pelvis

Front view
- Pelvic inlet – upper portion - “Female” pelvis
- Middle part – pelvic cavity - Has an inlet that is well rounded forward and
- Lowst part – pelvic outlet backward
- Has a wide pubic arch
Linea terminalis - Ideal type for type of childbirth
- The line that separates between true and - Most common type of pelvis for women;
false pelvis “child-bearing hips”
- Imaginary line - Women with Coca-Cola body have a
gynecoid shaped pelvis
- Has an easy passage of fetal skull and
shoulders

MABALOT, Christianne Jacob O. 3

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

Android Platypodid-shaped pelvis

- Male pelvis - Flattened pelvis

- The pubic arch forms an acute angle,
making the lower dimensions of the pelvis
extremely narrow
- Fetus may have difficulty exiting from this
type of pelvis
o Could lead to cesarean delivery or
forceps delivery or vacuum delivery
- Smoothly curved oval inlet, but the
anteroposterior diameter is shallow
- The pelvis is super wide and big that it
causes a lot of factors to have a difficulty
delivering the baby since the shape of the
pelvis is a flattened oval
- Obese women in the US have a flattened
pelvis

Anthropoid-shaped pelvis SUMMARY

- Ape-like pelvis
o Why ape? It is shaped like a face of Gynecoid
a monkey - Common for childbirth
- The transverse diameter is narrow - Ideal for women that are in their
- The anteroposterior diameter of the inlet is reproductive years
larger than usual - 50% of women have this pelvis
- It’s oval with longer anteroposterior
diameter Pelvis is also a determination if you should have
a CS or vacuum kind of birth

Android
- 20% women have this type of pelvis
- If you don’t have a curved body –

MABALOT, Christianne Jacob O. 4

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

Platypeloid SAGITTAL VIEW

- Super wide hips

Anthropoid
- Straight type of body but dili sapiot ang
lubut?

ADDITIONAL NOTES WHICH ARE

CONNECTED TO THE TABLE:
Occipitoanterior –
Pelvic inlet is considered adequate for vaginal
- Occipito – presentation is in the occiput
delivery if the measurement of these conjugate are
- Flexion – fully flexed
as follows:
- Chin is touching chest ‘
- True conjugate – 4 3/8” (11cm) or greater
- Diagonal conjugate – 4 7/8” to 5 1/8” (12.5
Platypeloid (usual mode of delivery)
cm to 13cm)
- Size of fetal skull should be proportionate
- Obstetric conjugate – 10cm
with the diameter or measurements of
pelvic cavity itself
PELVIC OUTLET DIAMETERS AND
MEASUREMENTS
PELVIC INLET DIAMTERS AND
MEASUREMENTS
- Pelvic inlet – located in the true pelvis,
upper part of the true pelvis
ANTEROPOSTERIOR VIEW

Considered adequate for vaginal delivery are as

follows:
- Anteroposterior diameter – 4 5/8 inches
(11.7 cm)
o From the symphysis pubis to coccyx
- Transverse or intertuberous diameter – 3
- Anteroposterior diameter – 11cm 7/8 to 5 3/8 (10 to 13.5 cm)
o From the pubis to the sacrum = o From ischial tuberosity to the other
anteroposterior side of the ischial tuberosity
- Transverse diameter – 13.5 cm or greater o Just remember the centimeters
or 5 3/8 inches - Posterior sagittal diameter (oblique) – 9cm
o From the ilium to ilium of the pelvis or 3 ½ either left or right
- Oblique diameter – 12.7 cm or 5 inches
SOFT TISSUES
- Play a role in labor and delivery
- The lower segment of the uterus expands to
accommodate the uintrauterine contents as
the wall of the upper segment thicken
o Fthere are a lot of factors which
cause the uterine wall to soften

MABALOT, Christianne Jacob O. 5

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

which aids the passage of the baby

going out
- The cervix is drawn up and over the
presenting part as it desceneds
- The vaginal canal distends to accommodate
passage of fetus

PASSENGER
- Refers to the fetus or fetal skull and it’s - The bones meet at the suture lines (red
ability to move through the passage and lines) composed of strong, flexible, fibrous
affected by several fetal features tissue which allow the cranial bones to move
- Focus: and overlap, making it possible for the skull
o Presentation to decrease in size
o Attitudes - Important to know type of sutures
o Station
o Lie position FETAL SKULL DIAMETERS:

FETAL SKULL

- Smallest diameter of the fetal skulls enters

the pelvis first
- Size is important as the fetus travels through - The head can flex and extend 45 degrees
the birth canal and rotate 180 degrees, which allows its
- Significant during the labor and delivery as smallest diameter to move down the birth
we also check for any disability canal and pass through the maternal pelvis
- Skull is compressible and made mainly of - Baby might rotate on its own during
thin pliable tubular flat bones childbirth
- Contains 8 bones
o 2 fused frontal bones SUTURES
o 2 parietal bones
o 1 occipital bones
- Anchored to the rigid and incompressible
bones at the base of the skull
- Other 4 bones of the skull
o Sphenoid
o Ethmoid
o 2 temporal bones

- Sutures – seams between bones of the skull

- Types of sutures
MABALOT, Christianne Jacob O. 6
BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

o Coronal – Frontal and parietal - It denotes the position of the head in

o Lambdoid – Occipital and parietal relation to the maternal pelvis
o Sagittal – The two parietal bones
o Squamous (can be viewed laterally) DIAMETERS OF THE FETAL SKUlL
– Parietal and temporal
- These sutures are the ones that compress
the bones

FONTANELLES

- BIPARIETAL – bones involved in the

measurement

BIPARIETAL DIAMETER (9.25 CM)

- Smallest diameter of fetal skull
- Also called transverse dieameter
- Extends between 2 parietal bones or
- Comes from a Spanish word called little
eminences
fountains
- Whatever may bte he position of the head,
- Flexible fibrous tissue
this diameter nearly always engages
- 2 fontanelles (very significant):
o Anterior fontanelle
SUBOCCIPITOBREGMATIC DIAMETER (9.5CM)
o Posterior fontanelle
- Smallest anteroposterior diameter
- Gaps between suture lines
o Bregma – forehead
o Occipito – occiput
Anterior fontanel - Measured up to down
- Diamond-shaped - Measured from the inferior aspect of the
- Located at the juncture of the frontal and occiput to the center of the anterior
parietal bones fontanelle
- Measures 1 1/8 inch to 1 5/6 inches (3-4cm)
long and ¾ inches to 1 1/8 inch or 2-3cm OCCIPITOMENTAL DIAMETER (13.5 CM)
wide
- Closed about 12-18 months
- Formed by joining of the 4 sutures (2 frontal
bones and 2 parietal bones)

Posterior fontanel
- Triangular shaped
- Formed by the junction of the 3 suture lines
(sagittal suture anteriorly and lambdoidal
suture on either side)
- Widest anteroposterior diameter
- Measures about 0.5 to 1cm across
- Measured form the posterior fontanelle to
- Closes on about 8-13 weeks
the chin
- It is membranous at first but becomes bony
- This diameter is usually what we are going
at term
to see if the fetus or baby is in full flexion
- Nomenclature as fontanel ismisnomer
MABALOT, Christianne Jacob O. 7
BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

(good flexion) since the baby of the chin of POOR FLEXION RESULTS TO:
the baby will touch the chest

DEGREE OF FLEXION
- Important during labor/delivery since this is
where we can determine that the baby is or
will pass the passage or the maternal pelvis
in good condition

FULL FLEXION

If baby has a very unusual fetal position, it usually

involves a lot of factors
1. Mother is small
2. Baby is not very accurate during delivery à
malposition à poor flexion
3. Small uterus à baby could be curled
4. Mal formed fetus
- Fetal head flexes so sharply 5. Uterine fibroids
- Chin rests on the chest 6. Unusual placental site – example, if the
- Smallest anteroposterior diameter and baby has a really bad position the placenta
suboccipitobregmatic diameter is presents could dislodge, implant, or block
the birth canal 7. Poor flexion due to large fetus and mother’s
- Type of cephalic presentation – vertex uterus is small which could lead à cesarean
(most reliable presentation during childbirth delivery
8. Multiple fetuses
MODERATE FLEXION a. Example – Twin A is in good position
- Occipitofrontal which means we can deliver it
diameter presents successfully. So, during that time if
the birth canal Twin B is in a bad position or
o Refers that mispositioned à cesarean delivery.
the brow b. We can delivery both twins vaginally
(kilay) or if mother has good pelvis
face which is measurement and if the babies’
poor flexion position are in a good position or full
flexion
POOR FLEXION
- Head is MOLDING
hyperextended
- Largest diameter
- Occipitomental
diameter presents
the birth canal

- Overlapping of the skull bones along the

suture
- Change in shape of the fetal skull to long
and narrow shape that facilitates passage
through the rigid pelvis
MABALOT, Christianne Jacob O. 8
BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

- Only lasts a day or two PARTIAL EXTENSION

- Very normal - Presents the brow of the head to the birth
- Alteration of the fore coming head while canal
passing through the resistant birth passage
during the labor COMPLETE OR FULL EXTENSION
o However, there is very little alteration - Unusual position
in size of the head as a volume of the - Occurs when there is less or minimal
content inside the skull is amount of amniotic fluid or
incompressible. Although, small oligohydroamnios
amount of CSF cand blood can - The face and the chin ang problem
escape in the process
- During the normal delivery, an alteration of FETAL LIE
4mm in the skull diameter commonly occurs
but disappears eventually
- Caused by pushing then going back then
push again, dapat push diretso
- It is normal to defecate during delivery since
as the baby goes outside, the surrounding
tissue and sigmoid colon will be
compressed.

FETAL ATTITUDE
- Relationship between the long
(cephalocaudal) axis of the fetal body to the
long cephalocaudal axis of the woman’s
body

LONGITUDINAL LIE
- Classified as cephalic or breech
- Head is below or above
o Head is below – cephalic
presentation
- Describes the degree of flexion a fetus o Head is above – breech
assumes during labor and delivery or the presentation
relation of the fetal parts of each other o Transverse lie/shoulder
- Complete or full flexion presentation – fetus is
- Face/chin presentation perpendicular to the mother’s axis
- Occurs 96% of pregnancies
COMPLETE FLEXION
- Good attitude TRANSVERSE LIE
- The usual fetal position - Long axis of the mother is perpendicular to
- Advantageous for birth because it helps the fetus
fetus presents the smallest anteroposterior
diameter of the skull
- Occupies the smallest space possible

MODERATE FLEXION
- Chin is not touching the chest anymore
- “Military Position” or “Military Presentation”

MABALOT, Christianne Jacob O. 9

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

Chephalohematoma
FETAL PRESENTATION - Bleeding of the periosteum

Cephalic Presentation
- Head presents first
- Most common types of presentation/types
presentation
o Vertex
o Brow
o Face – poor flexion
- Fetal body part that wil be first to pass
o Mentum (chin) or complete
through the cercix and delivered
extension
- Determined by the fetal attitude, lie, and
position
Breech presentation
- Affects duration and difficulty of labor and
affects method of delivery

DIFFERENT CONDITIONS:
Caput Succedaneum
- Cap goes across
the suture lines
- Boggy edematous
swelling of the fetal - When the buttocks or feet are presented
scalp first
- Disappears without - Types of brech presentation
treatment o Complete
- Molding – when the o Frank
fetal bones are o Footling
overlapping; caput § Single
succedaneum; head § Double
is swollen (edema) - Presenting part for breech presentation –
- Disappears without treatment sacrum
- No pathological significance

Cephalhematoma
- Edema or
swelling of
fetal scalp

Subgaleal
hemorrhage
- Bleeding in
the specific
portion of the
head of the
baby
(subgaleal space)
w
- E

MABALOT, Christianne Jacob O. 10

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

SHOULDER PRESENTATION

- Presenting part is the shoulder, iliac crest,

hand, and elbow
- Fetus is lying horizontally in the pelvis
- Result – perpendicular ROP
- Causes - Refers to right occipital posterior
o Relaxation of the abdominal walls - So, right part of the maternal pelvis, occiput
o Pelvic contraction for the fetus, and posterior for the maternal
o Placenta previa pelvis
o Polyhydroamnios – a lot of fluid that
is filled in the abdominal wall of the LOP
mother à turning of baby - Left part for the maternal pelvis
- Occiput for the fetus
FETAL POSITION - Posterior part of the pelvis

ROA
- Right occipitoanterior
o Right side of the maternal pelvis
o Occiput for the fetus
o And anterior portion of the maternal
pelvis or quadrant

Four landmarks to describe the presenting part to

one of the pelvic quadrants
1. Vertex – occiput
2. Face – chin (mentum)
- Relationship of the presenting part to the
3. Breech – sacrum
specific quadrant or part and side of a
woman’s pelvis
- Maternal pelvis is divided into 4 quadrants
- Four parts of the fetus are chosen as
landmarks
- 4 parts of the fetus are also chosen as
landmarks

MABALOT, Christianne Jacob O. 11

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

4. Shoulder – acromion process

STATION

-LOA – most common fetal position

-ROA – second most common fetal - Refers tp the relationship of the presenting
position part of the fetus to the level of the ischial
Fetus is born fastest on either position spine

FETAL ENGAGEMENT 7 CARDINAL MOVEMENTS

(EDFIREERE)
- Engagement
- Descent
- Flexion
- Internal
- Rotation
- Extension
- External
- Rotation
- Expulsion
- Settling of the presenting part of the fetus
far enough into the pelvis that it rest to the
level of the ischial spine, midpoint of the
POWER
- Extent of push that the mother will exert
pelvis
during the delivery
- The degree of engagement is established
- Third important requirement for successful
by a vaginal examination
labor
o Floating – presenting part is not
- Force supplied by the fundus of the uterus
engaged
and implemented by uterine contractions,
o Dipping – descending but not yet
which causes cervical dilatation and
touched the ischial spine
expulsion of the fetus
- What happens when you push and abdomen
is not contracted? Laceration

UTERINE CONTRACTIONS

MABALOT, Christianne Jacob O. 12

BSN2-E
 MATERNAL CHILD NURSING NCM 107 Theory
Care of Mother, Child, Adolescent (Well-Client) Theory October 19, 2021
Cebu Doctors’ University

TRUE LABOR o L4 – pelvic

- Contractions are regular: § Determine if baby is engaged
o Regular or floating
o Increase in intensity and duration
with walking PSYCHE
o Felt in lowerb ack, radiating to lower - Woman’s psychological state which may or
portion of the abdomen inhibit labor
- Bloody show - Can be based on past experience as well as
- Dilation and effacement her present psychological state
- Fetus usually engaged - There are a lot of women nowadays where
there are increased psychological problems
FALSE LABOR after birth
o Postpartum depression à
- Contractions are irregular
postpartum psychosis à postpartum
- Often stop with walking
depression
- Contractions felti n the abdomen above
o Responsibility – educate and orient
umbilicus (does not radiate in the back or
and give awareness most especially
vice versa)
to first-time, single mothers or
- No change in cervix
mothers who are not financially
- Fetus is ballotable
capable in having a kid also mga
multigravida mothers

LEOPOLD’S MANEUVER

- Systematic method of palpation to

determine fetal presentation and position
- Done as part of physical examination
- Grips:
o L1 – fundal grip
§ Findings – fundal height and
content
o L2 – pelvic grip
§ Findings – fetal back, fetal
small sparts, and fetal heart
tone
o L3 – umbilical grip
§ Determine whether fetus is
cephalic or breech
MABALOT, Christianne Jacob O. 13
BSN2-E