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MECHANISM OF LABOUR
MECHANISM OF LABOUR

Refers to;

  • The series of changes in position and attitude that the fetus undergoes during its passage through the birth canal.

ENGAGEMENT

  • The negotiation of the widest diameter of the

presenting part, through the pelvic brim.

  • Description of engagement in fifths

  • 5/5-floating above the brim.

  • 4/5-fixing

  • 3/5-not engaged

  • 2/5-just engaged

  • 1/5-engaged

Diameters of the Maternal Pelvis

  • Inlet -- Transverse diameter 13.5cm -- Antero-posterior diameter 11cm

  • Mid Cavity -- Transverse diameter 12cm -- Antero-posterior diameter 12cm

  • Outlet -- Antero-posterior diameter 13.5cm -- Transverse diameter 11cm

Presenting diameters of a fully flexed head  Longitudinal diameter: suboccipito bregmatic (saggital plane)-9.5cm  Transverse
Presenting diameters of a fully flexed
head
Longitudinal diameter: suboccipito bregmatic
(saggital plane)-9.5cm
Transverse diameter: Biparietal diameter
(coronal plane)-9.5cm
Mechanism of labour in vertex presentation & gynaecoid pelvis While the head descends it makes five
Mechanism of labour in vertex
presentation & gynaecoid pelvis
While the head descends it makes five
movements.
 Flexion: uterine contractions exert pressure on the long axis of the fetus and cause head
Flexion: uterine contractions exert pressure on the
long axis of the fetus and cause head to fully flex by
a lever mechanism on the occipitospinal joint.
 Internal rotation: when the desceding head meets the resistance of the pelvic floor, with the
 Internal rotation: when the desceding head meets
the resistance of the pelvic floor, with the sloping
gutter of the levator-ani muscles the occiput rotates
forward from transverse/oblique (occipito
anterior)position to lie directly under the pubic arch.
 Extension: following completion of internal rotation the occiput is underneath the symphysis pubis and the
 Extension: following completion of internal rotation
the occiput is underneath the symphysis pubis and
the bregma is near the lower boader of the sacrum.
The well flexed head now extends, with the occiput
escaping from underneath the symphysis pubis and
starting to distend the vulva. This is known as the
crowning of the head.
  • Restitution: At the time of internal rotation the head gets twisted on the shoulders. When the head is fully delivered it resumes its normal position in relation to

shoulders. This movement of the head, which is one

eighth of a circle is known as restitution.

 External rotation: Once the shouders meet the resistance of the pelvic floor, rotation occurs making
 External rotation: Once the shouders meet the
resistance of the pelvic floor, rotation occurs making
the shoulders occupy the antero-posterior diameter
of the pelvic outlet. This rotation is also one eighth of
a circle.
  • Delivery of the body: The anterior shoulder is under the symphysis pubis and delivers first by downward movement, followed by the posterior shoulder.The body is delivered by lateral flexion.