MECHANISM OF LABOUR (NORMAL and ABNORMAL)分娩.ppt

MECHANISM OF LABOUR (NORMAL ABNORMAL) Presented By Dr. ZEINAB ABOTALIB MRCOG, DGO, Associate Professor Consultant Obs/Gyna Infertility IVF Lie, presentation, attitude, position FETAL LIE The relation of the long axis of the fetus to that of the mother Longitudinal lie is found in 99% of labours at term Predisposing factors for transverse lie/oblique lie ? multiparity, placenta previa, hydramnious, uterine anomalies FETAL PRESENTATION The presenting part is the portion of the body of the fetus that is foremost in the birth canal The presenting part can be felt through the Cx on vaginal examination Longitudinal lie ? cephalic presentation ?breech presentation Transvrse lie ? shoulder presentation Lie, presentation, attitude, position CEPHALIC PRESENTATION Head is flexed sharply ? vertex / occiput presentation Head is extended sharply ? face presentation Partially flexed ? bregma presenting (sinciput presentation) Partially extended ? brow presentation BREECH PRESENTATION Frank breech Complete breech Footling breech ATTITUDE Posture of the fetus ?folded on itself to accommodate the shape of the uterus Flexed head, thighs, knees feet The arms crossed over the chest Face presentation ?extended concave contour of the vertebral column POSITION The relation of an arbitrary chosen point of the fetal presenting part to the Rt or Lt side of the maternal birth canal The chosen point Vertex presentation ? occiput Face presentation ? mentum Breech presentation ?Sacrum Each presentation has two positions Rt or Lt Each position has 3 varieties : Ant, transverse, post FREQUENCY OF VARIOUS PRESENTATIONS POSITIONS AT TERM Vertex ? 96% 2/3 ?Lt 1/3 ?Rt Breech ? 3.5% Face ?0.3% Shoulder ?0.4% MECHANISM OF LABOUR WITH OCCIPUT PRESENTATIONSTHE CARDINAL MOVEMENTS OF LABOUR 1-ENGAGEMENT The greatest transverse diameter BPD passes through the pelvic inlet It may occur in the last few weeks of pregnancy or only in l