![]() As hands move toward the pelvic brim, assess for the following: if the hands converge (come together) around the presenting part, it is floating if the hands diverge (move apart), the presenting part is either dipping or engaged in the pelvis. If the cephalic prominence is felt equally on both sides: military position (common in posterior position), or nonflexed. If the cephalic prominence is felt on the same side as the back: occiput (or crown), fetal vertex slightly extended. If the cephalic prominence is felt on the same side as the small parts: sinciput (fetus’ forehead), fetus vertex is flexed. The examiner presses deeply with the fingertips, toward the symphysis pubis, locating the cephalic prominence. The examiner places their hands on each side of the uterus, below the umbilicus and pointing toward the symphysis pubis. ![]() Engagement of fetal head is When the widest diameter of the presenting part has passed through the pelvic inlet. Cephalic malpresentation includes all the clinical entities in which the fetal head is deflexed and may lead to a protracted active phase of labor, arrest of dilatation during the first stage, and arrest of descent in the second stage owing to the presenting part being unable to successfully negotiate the pelvic inlet and descend into the birth. Engagement in primigravida occurs at Beginning of labour. Suboccipitofrontal is the commonest diameter of engagement. In this maneuver, the examiner faces the woman’s feet. Flexion, Extension & Internal rotation and Descent are the cardinal movements of the head in normal labour. The cardinal movements are: engagement, descent, flexion, internal rotation, extension, external rotation and expulsion. This normally occurs 2-3 weeks before labour in. Changes in the position of the fetal head, occurring with a vertex presentation, as it descends through the birth canal and exits the mother’s body. Trauma during labor may cause tracheal and laryngeal edema immediately after delivery, which can result in neonatal respiratory distress. This can happen a few weeks before delivery and is also known as lightening. This is the head in the pelvis engaged in and not moving back up. These are the movements that the fetus does to find its way out. Engagement: Engagement is the descent of the widest part of the fetus through the pelvic inlet. The mechanism of labor consists of the cardinal movements of engagement, descent, flexion, internal rotation, and the accessory movements of extension and external rotation. The mechanisms of labor are known as the cardinal movements. ![]() The fetus negotiates the birth canal and rotational movements are necessary for descent. Seven discrete cardinal movements of the fetus occur over the course of labor and delivery: engagement, descent, flexion, internal rotation, extension, external rotation or restitution, and expulsion. German and older English literature list four movements as the cardinal movements. Fourth maneuver (fetal attitude and engagement) (see Figure 37-7D)-determines flexion or attitude of the fetal vertex or the greatest prominence of the fetal head over the pelvic brim. The mechanics of labor describe the forces required for fetal descent, and the movements that the fetus must perform to overcome the resistance met by the maternal bony pelvis and soft tissue.
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