Normal Intrapartum-Labor/Delivery

Passenger:
Fetal factors
• Head size
o Flexible skull
o Can collapse and override each other to get out of the passage
• Shoulder size
o Shoulder dystocia- occurs when the shoulders are too wide and they get
stuck under symphysis pubis
o Need to fit through the pelvis
• Fetal Presentation/Position
o Part of the fetus that is entering pelvic inlet first
§ Occiput – back of the head
§ Mentum – chin
§ Scapula – shoulder
• a transverse lie and accounts for only 0.3% of births
• occurs more often with preterm birth, high parity, prematurely
ruptured membranes, hydramnios, and placenta previa
• cesarean birth is necessary when the fetus is viable (one of a
gestational age that might survive)
§ Breech – sacrum or feet
• more common in preterm births, hydrocephaly(enlargement of the
head with fluid), multiple gestations, abnormalities of the maternal
uterus and pelvis, and with placenta previa (placenta in the lower
uterus)
• Breech presentations are associated with the following
disadvantages:
• buttocks are not smooth and firm like the head and are
less effective at dilating the cervix.
• fetal head is the last part to be born. By the time the
fetal head is deep in the pelvis, the umbilical cord is
outside the mother’s body and is subject to
compression between the fetal head and the maternal
pelvis.
• because the umbilical cord can be compressed after the
fetal chest is born, the head should be delivered quickly
to allow the infant to breathe. This does not permit
gradual molding of the fetal head as it passes through
the pelvis.
• breech presentation has the following three variations,
depending on the relationship of the legs to the body:
• Frank breech—This is the most common variation,
occurring when the fetal legs are extended across the
abdomen toward the shoulders
• Complete breech—This is a reversal of the usual
cephalic presentation. The head, knees, and hips are
flexed, but the buttocks are presenting
• Footling breech—This occurs when one or both feet are
presenting