![]() Finally, a history of present illness, review of systems, and physical exam, including a sterile speculum exam, will need to take place.ĭuring the sterile speculum exam, clinicians will look for signs of rupture of membranes such as amniotic fluid pooling in the posterior vaginal canal. The patient's prenatal record, including obstetric history, surgical history, medical history, laboratory, and imaging data, should undergo review. The patient should be placed on continuous cardiotocographic monitoring to ensure fetal wellbeing. When women first present to the labor and delivery unit, vital signs, including temperature, heart rate, oxygen saturation, respiratory rate, and blood pressure, should be obtained and reviewed for any abnormalities. It is up to the clinician to determine if the patient is in labor, defined as regular, clinically significant contractions with an objective change in cervical dilation and/or effacement. Common chief complaints include painful contractions, vaginal bleeding/bloody show, and fluid leakage from the vagina. Women will often self-present to obstetrical triage with concern for the onset of labor. Initial Evaluation and Presentation of Labor Medical professionals use the information they obtain from monitoring and cervical exams to determine the patient's stage of labor and monitor labor progression. Cardiotocography is used to monitor the frequency and adequacy of contractions. Fetal heart monitoring is employed nearly continuously to assess fetal well-being throughout labor. Serial cervical examinations are used to determine cervical dilation, effacement, and fetal position, also known as the station. Clinicians typically use multiple modalities to monitor labor. This triad is classically referred to as the passenger, power, and passage. Successful labor involves three factors: maternal efforts and uterine contractions, fetal characteristics, and pelvic anatomy. The first stage is further divided into two phases. All rights reserved.Labor is the process through which a fetus and placenta are delivered from the uterus through the vagina. The information gathered by clinical examination and ultrasound should be integrated into clinical decision making.Ĭardinal movements fetal attitude fetal descent fetal position mechanics of labor ultrasound.Ĭopyright © 2021 The Authors. Ultrasound offers a historically unique opportunity for noninvasive, dynamic studies of the mechanics of labor. We would argue that descent is the main purpose of the uterine powers and cardinal movements, a description of the rotational movements the fetal head and shoulders must perform to obtain descent. German and older English literature lists only 4 rotational movements as the cardinal movements and excludes engagement, descent, and expulsion. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. The fetus negotiates the birth canal and rotational movements are necessary for descent. ![]() Electronic address: 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. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway (Drs Kahrs and Eggebø) Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway (Drs Kahrs and Eggebø) Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway (Dr Eggebø). ![]()
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