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Seven Cardinal Movement

and expulsion . internal rotation. flexion.The cardinal movements of labor are . descent. engagement. extension. external rotation.


.Engagement The mechanism by which the biparietal diameter—the greatest transverse diameter in an occiput presentation—passes through the pelvic inlet is designated engagement.

(3) bearingdown efforts of maternal abdominal muscles.Descent • This movement is the first requisite for birth of the newborn. (2) direct pressure of the fundus upon the breech with contractions. and (4) extension and straightening of the fetal body. . descent usually begins with engagement. engagement may take place before the onset of labor. • In nulliparas. and further descent may not follow until the onset of the second stage. In multiparous women. • Descent is brought about by one or more of four forces: (1) pressure of the amnionic fluid.

or pelvic floor. then flexion of the head normally results. the chin is brought into more intimate contact with the fetal thorax. walls of the pelvis. • In this movement.Flexion • As soon as the descending head meets resistance. and the appreciably shorter suboccipitobregmatic diameter is substituted for the longer occipitofrontal diameter . whether from the cervix.


.Internal rotation • This movement consists of a turning of the head in such a manner that the occiput gradually moves toward the symphysis pubis anteriorly from its original position or less commonly. except when the fetus is unusually small. posteriorly toward the hollow of the sacrum. • Internal rotation is essential for the completion of labor.


on reaching the pelvic floor. If the sharply flexed head. .Extension • After internal rotation. did not extend but was driven farther downward. the sharply flexed head reaches the vulva and undergoes extension. it would impinge on the posterior portion of the perineum and would eventually be forced through the tissues of the perineum.

The resultant vector is in the direction of the vulvar opening. The first force. acts more anteriorly. and the second.• When the head presses upon the pelvic floor. exerted by the uterus. thereby causing head extension. acts more posteriorly. however. supplied by the resistant pelvic floor and the symphysis. . two forces come into play.

bregma. mouth. the head drops downward so that the chin lies over the maternal anus. an increasingly larger portion of the occiput gradually appears.• This brings the base of the occiput into direct contact with the inferior margin of the symphysis pubis with progressive distension of the perineum and vaginal opening. . forehead. and finally the chin pass successively over the anterior margin of the perineum • Immediately after its delivery. nose. The head is born as the occiput.

If it was originally directed toward the right. one shoulder is anterior behind the symphysis and the other is posterior. This movement corresponds to rotation of the fetal body and serves to bring its bisacromial diameter into relation with the anteroposterior diameter of the pelvic outlet. the occiput rotates to the right. Thus. If the occiput was originally directed toward the left.External rotation • The delivered head next undergoes restitution. Restitution of the head to the oblique position is followed by completion of external rotation to the transverse position. This movement apparently is brought about by the same pelvic factors that produced internal rotation of the head . it rotates toward the left ischial tuberosity.

Expulsion Almost immediately after external rotation. the anterior shoulder appears under the symphysis pubis. and the perineum soon becomes distended by the posterior shoulder. After delivery of the shoulders. the rest of the body quickly passes .