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passage refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum

Two pelvic measurements:
 The

diagonal conjugate(the anteroposterior diameter of the inlet)- it is the narrowest diameter at the pelvic inlet  Transverse diameter of the outlet- it is the narrowest diameter at the outlet


PASSENGER  The passenger is the fetus  The body part of the fetus that has the widest diameter is the head  Whether a fetal skull can pass depends on both its structure(bones. frontanelles. and suture lines) and its alignment with the pelvis .

and 2 temporal bones lie at the base of cranium  The chin. 2 parietal.STRUCTURE OF THE FETAL SKULL Cranium.uppermost portion of the skull.frontal. referred to by its Latin name mentum.sphenoid. can be a presenting part  . is composed of 8 bones > 4 superior bones. and occipital > other 4 bones of the skull. ethmoid.

. Sagittal suture joints-2 parietal bones of the skull  Coronal suture.line of juncture of the frontal bones and the 2 parietal bones  Lamboid suture.line of juncture of the occipital bone and the 2 parietal bones.

found at the junction of the main suture lines .Frontanelles- significant membrane.covered spaces.

2 to 3 cm.its anteroposterior diameter measures approximately 3 to 4 cm. closes when infant is 12 to 18 months of age .diamond shaped . its transverse diameter.lies at the junction of the coronal and sagittal sutures .> anterior frontanelle(bregma).

> posterior frontanelle.lies at the junction of the lamboidal and sagittal sutures .triangular shaped .smaller than the anterior frontanelle .

area over the occipital bone .area over the frontal bone Occiput.Vertex- space between the two frontanelles Sinciput.


5 cm) is from the inferior aspect of the occiput to the center of the anterior frontanelle .DIAMETERS OF THE FETAL SKULL  The diameter of the anteroposterior skull depends on where the measurements is taken.  The narrowest diameter (approximately 9.

 The occipitofrontal diameter.5 cm) is measured from the posterior frontanelle to the chin . measured from the occipital prominence to the bridge of the base is approximately 12 cm  The occipitomental diameter(approximately 3.

is the narrowest diameter at the pelvic inlet  So to be born easily. a space approximately 11 cm wide. The anteroposterior diameter of the pelvis.25 cm) . a fetus must present a parietal diameter. the narrowest diameter(approximately 9.

the fetus must rotate to present the narrowest fetal head diameter to the maternal transverse diameter. At the outlet. a space approximately 11 cm wide .

engagement. If a fetus presents the anteroposterior diameter of the skull to the anteroposterior diameter of the inlet. may not occur . or settling of the fetal head into the pelvis.

and the smallest anteroposterior diameter. the suboccipitobregmatic. is presented to the birth canal Full Flexion Moderate Flexion • the occipitofrontal diameter will be presents • the largest diameter will present Poor Flexion .DEGREE OF FLEXION OF THE FETAL HEAD • a fetal head flexes so sharply the hin rests on the chest.


5 cm will fit through a pelvis much more readily than if the diameter is 12.> it follows a fetal head presenting a diameter of 9.5 cm .0 to 13.

dilated cervix  Molding is commonly seen in infants after birth .MOLDING A change in the shape of the fetal skull produced by the force of uterine contractions pressing the vertex of the head against the notyet.

generally. the coronal suture line can be easily palpated in the newborn skull  No skull molding occurs when a fetus is breech. are presented first . not the head. The overlapping of the sagittal suture line and. because the buttocks.

POWERS OF LABOR UTERINE CONTRACTIONS Origins.labor contractions begin at a “pacemaker” point located in the uterine myometrium near one of the uterotubal junctions .

contractions appear to originate at the lower uterine segment rather than in the fundus. If so. These are reverse. and they may actually cause tightening rather than dilation of the cervix  Some women seem to have additional pacemaker sites in other portions of the uterus. contractions can be uncoordinated  .In some women. ineffective contractions.

3 Phases Increment- when the intensity of the contraction increases Acme.when the intensity decreases .when the contraction is at its strongest Decrement.

 Between relaxes  As labor progresses. the uterus . increasing from 20 to 30 seconds to a range of 60 to 90 seconds contractions. the relaxation intervals decrease from 10 minutes early in labor to only 2 to 3 minutes  The duration contractions also changes.

the uterus gradually differentiates itself into 2 distinct functioning areas: > the upper portion becomes thicker and active.Contour Changes  As labor contractions progress and become regular and strong. preparing it to be able to exert the strength necessary to expel the fetus when the expulsion phase of labor is reached .

> the lower segment becomes thin walled. so that the fetus can be easily pushed out of the uterus  As these events occur. supple. and passive. the boundary between the two portions becomes marked by a ridge on the inner uterine surface. the physiologic retraction ring .

the canal virtually disappears  In primaras. effacement is accomplished before dilatation begins . the canal is approximately 1 to 2 cm long  With effacement.CERVICAL CHANGES  Effacement- shortening and thinning of the cervical canal  Normally.

refers to the enlargement or widening of the cervical canal from an opening a few millimeters wide to one large enough(approximately 10 cm) to permit passage of a fetus . In multiparas. dilatation may proceed before effacement is complete  Dilatation.

the presenting part serves this same function  . they push ahead of the fetus and serve as an opening wedge. If the membranes are intact.filled membranes press against the cervix.Dilation occurs for 2 reasons: Uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus  The fluid. If they are ruptured.


refers to the psychological state or feelings that a woman brings into labor .Psyche  Woman’ s psychological outlook.