![]() The chin, mouth, nose, forehead and finally the occiput emerge. This set of movements is observed as external rotation of the shoulder, with the fetal back facing upwards. However, if the chin becomes anterior, rotational dystocia will occur. Totally flexed, the head goes through an internal rotation motion to place the occiput under the symphysis. The anterior shoulder is wedged under the symphysis pubis at the level of the acromion, while the posterior shoulder pushes the coccyx backwards and is expelled, followed by expulsion of the anterior shoulder. Because of the asymmetry of the shape of both the fetal head and the maternal bony pelvis, such rotations are required for the fetus to successfully negotiate the birth canal. Six cardinal movements of labor occur during the second stage of labor. Cardinal movements in labor the changes on position of fetal head during its passage through the birth canal. The maximum accepted time for the second stage depends on the patients parity and whether the patient has an epidural. ![]() The biacromial diameter then becomes anteroposterior, the fetal back points to the maternal right or left side, and the head begins to flex. The second stage of labor is the time between complete cervical dilation and delivery of the neonate. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal. The upper limbs are forced into flexion, shortening the biacromial diameter before assuming an oblique diameter. The fetus negotiates the birth canal and rotational movements are necessary for descent. This is required for fetal descent through the birth canal. The abdomen and the most inferior portion of the fetal chest are expelled. To accommodate itself to the maternal pelvic dimensions, the fetus must undergo a series of changes in the attitude of its presenting part. In complete breech presentation, the lower limbs are usually expelled at the same time as the buttocks. The posterior buttock pushes the coccyx backwards, distends the perineum, and then becomes exteriorized, which fully releases the anterior buttock. The anterior buttock descends under the pubic bone and begins to open the vulvar orifice. In the anterior positions, a 45-degree backward rotation in the posterior positions, a 45-degree forward rotation occurs. ![]() The bitrochanteric diameter descends obliquely with slight posterior asynclitisim ( the posterior buttock descends ahead of the anterior buttock, the intergluteal cleft is closer to the pubis than to the sacrum).Įngagement usually occurs in an oblique position (left sacrum anterior, right sacrum anterior, left sacrum posterior, right sacrum posterior).Ī 45-degree internal (ie, in the birth canal ) rotation occurs.
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