Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                

NCM 107 Module 2F

Download as pdf or txt
Download as pdf or txt
You are on page 1of 15

NCM 107: Care of Mother, Child, Adolescent (Well-Client)

Module 2F: Obstetric Anatomy Premature Death


- A mother who has vices all throughout her
pregnancy, drinking smoking, etc., has a
very bad psychological development not
- In this module, you will learn about the bony
just for her pregnancy but towards other
structures with the most importance for
people,
pregnant woman and the baby she will give - The mother is eating a lot of sugar or
birth to. unnecessary food intake
- The bones of the skeleton have the main ➔ We all know that sugar is prohibited
function of supporting our body weight and ➔ If there is too much consumption of it,
acting as attachment points for our muscle. it could lead to gestational diabetes
- The female pelvis supports the major load - The mother is also stressed all throughout
of the pregnant uterus and the fetal skull her pregnancy, eating a lot of unhealthy
which has to pass through the woman’s foods like pizza, coffee, bacon, wine, etc.
pelvis when she gave birth. ➔ Could result to signs and symptoms of
disability
Conceptual Framework ➔ It if is not treated, it could lead to
premature death not just for the mother
but also for the baby.

Labor
- A series of events by which uterine
contractions and abdominal pressure expel a
fetus and placenta from the uterus
- It is the process of delivering a baby and the
placenta, the membranes, and umbilical cord
from the uterus to the vagina to the outside
world
- In our conceptual framework, we have here
a mother who is pregnant First Stage of Labor
- Dilatation
High Level Wellness - The cervix dilates fully to a diameter of about
- If the mother is going through her regular 10 cm (2 inches)
prenatal checkups, the mother is also
performing yoga and exercises, eating a First stage of labor is divided into 2 phases:
lot of healthy foods and fruits and
1. Latent Phase
vegetables, have a good support system
2. Active Phase
and has a good psychological
development Theories of Labor
- The mother is aware of everything that is - Normally begins between 37 and 42 weeks
good for her baby and is educated ➔ As early as 37 or as late as 42
enough, then it will lead her to a high level
- If the labor can begin before fetus is mature
wellness
this is premature labor
- If labor occurs or is delayed until fetus and
placenta have both passed beyond the
optimal point for birth this is termed as post
term labor

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
- The exact mechanism that triggers the onset Passage
of labor is unknown - Refers to the maternal pelvis
➔ There are a lot of mechanism that could - Refers to the route that the fetus must travel
trigger the onset of labor from the uterus through the cervix and vagina
Current beliefs that focus on the combination of to the external perineum
occurrences as responsible for initiating the FOCUS:
start labor:
- Shape of Pelvis
➢ Uterine stretching - Bony Structures
➔ Also caused by hormones or increase or - Pelvic Diameter
decrease in hormones that could affect - Soft Tissues
the uterine wall
➢ Changes in estrogen and progesterone Pelvis
balance
➢ Oxytocin Stimulation
➢ Cervical Pressure
➢ Prostaglandin production by the fetus
➢ Aging of the placenta
➢ Increased Fetal Cortisol Level

Components of Labor
There are four (4) important components of labor
which must work together for a normal labor process - From an obstetrical standpoint, it is useful to
to begin: consider the bony pelvis as a whole rather
than a separated part
1. Passage
- A pelvis is a bony ring formed by four united
➔ Refers to the maternal pelvis itself
bones:
2. Passenger
1. Two innominate (flaring hip) bones
➔ A maternal pelvis should be suitable to
2. The coccyx
also the passenger which refers to the
3. The sacrum
fetus
- These four bones serve both to support and
3. Power
protect the pelvic organs
➔ Refers to the amount of push the mother
- These united bones together also form four
will exert during the delivery
joints
4. Psyche
➔ Or psychological development of the
mother is very important all throughout
her pregnancy process
➔ Could refer to the past experiences a
mother had prior to pregnancy
If one is altered in these four components of labor,
the outcome of labor can be adversely affected.

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Four Pelvic Joints Pelvic Divisions:
- The bony structures of the pelvis, including - The pelvis is anatomically divided into a
the pelvic joints and bones are important in False Pelvis and a True Pelvis
the labor and delivery.
1. Symphysis Pubis
2. Right Sacroiliac Joint
3. Left Sacroiliac Joint
4. Sacrococcygeal Joint
- Pelvic joints to provide stability to the pelvis.

- The bony line being the brim of the pelvis

False Pelvis
- located in the superior half of the pelvis
- the upper portion of the pelvic inlet
→ support the internal organs and upper body

True Pelvis
- located in the inferior half of the pelvis
Pelvis (Parts and Functions) - includes the pelvic inlet, pelvic outlet, and pelvic
- Vital in the birthing process cavity
- Innominate bones: ilium (upper and lateral - Chiefly of concerned of the obstetrician as it forms
portion), ischium (inferior portion), and pubis the canal through which the fetus has to pass
- Hip (the crest of the ilium) Pelvic Inlet
- Ischial tuberosities (important markers - entrance to the true pelvis
used to determine lower pelvic width) - also called as the pelvic brim
- Ischial spines (mark the midpoint of the Pelvic Outlet
pelvis) - inferior portion of the true pelvis
Pelvic Cavity
- Symphysis pubis
- space between the inlet and the outlet
- Sacrum (upper posterior portion of the pelvic
ring)
- Coccyx (below the sacrum)

Front View

Pelvic inlet is the upper portion while the middle


part is a pelvic cavity and the lower part or the
lowest part is the pelvic outlet.
- The line that separates between the true
pelvis and the false pelvis: Imaginary line
(LINEA TERMINALIS) which separates
the false pelvis from true pelvis

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Difference of a Male and a Female Pelvis

2. Android-shaped Pelvis
Male Pelvis - “Male” pelvis
- Its arc is only 70 degrees = acute angle - The pubic arch forms an acute angle, making
- It is much more narrower and longer than the the lower dimensions of the pelvis extremely
female pelvis narrow
- A fetus may have difficulty exiting from this
Female Pelvis type of pelvis
➔ Sometimes it could lead into cesarean
- Its arc is 90 to 100 degrees = obtuse angle
delivery or it could lead to a forceps
anatomically called sub arc
delivery or a vacuum delivery
- It is much broader and larger
➔ It depends on a lot of factors
Types of Pelvis
1. Gynecoid-shaped Pelvis
- “Female” pelvis
- Has an inlet that is well-rounded forward and
backward
- Has a wide pubic arch
- Ideal type for childbirth
- Most common type of pelvis for women
- This is what we call as the “child bearing 3. Anthropoid-shaped Pelvis
hips” - “Ape-like” pelvis
- A lot of women has a very perfect body like a ➔ Shaped as a monkey
wide hips and betty boop type of body, or in - The transverse diameter is narrow
old terms like coca-cola body - The anteroposterior diameter of the inlet is
- Easy passage of the fetal skull and the larger than usual
shoulders - It’s oval with longer anteroposterior diameter

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
4. Platypelloid-shaped Pelvis
- “Flattened” pelvis
- Has a smoothly curved oval inlet, but the
anteroposterior diameter is shallow
- The pelvis is super wide and super big that it
causes a lot of factors to have a difficulty
delivering the baby because the shape of this
pelvis is flattened oval
- A lot of women, mostly in the states, women
who are obese have a flattened pelvis, very
big and super wide hips

GYNECOID (50%) ANDROID (20%) ANTHROPOID (25%) PLATYPELLOID


(5%)
PELVIC BRIM Slightly ovoid or Heart shaped Oval, wider Flattened
transversely angulated anteroposteriorly anteroposteriorly
rounded
ROUND HEART OVAL FLAT
DEPTH Moderate Deep Deep Deep
SIDEWALLS Straight Convergent Straight Straight
ISCHIAL Blunt, somewhat Prominent, narrow Prominent, often with Blunt, widely
SPINES widely separated interspinous narrow interspinous separated
SACRUM Deep, Curved Slightly curved, Slightly curved Slightly curved
terminal portion
often beaked
SUBPUBIC Wide Narrow Narrow Wide
ARCH
USUAL MODE - Vaginal - Cesarean - Vaginal Vaginal
OF DELIVERY Spontaneous - Vaginal * Forceps - Spontaneous
(Occipitoanterior Difficult with * Spontaneous
position) forceps (Occipitoanterior/posterior
Position)

- 50% of women have gynecoid pelvis - Usual mode of delivery (gynecoid): normal
- 20% of women have android pelvis spontaneous vaginal delivery if the position
- 25% of women have anthropoid pelvis of the baby is in occipitoanterior position
- 5% of women have platypelloid presentation is on occiput

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
➔ Flexion is fully flexed: position of the baby
occipitoanterior, fully flexed meaning chin
is touching the chest
- Usual mode of delivery (android): usually
cesarean
➔ Women should assess first their body
types and pelvic types before getting
pregnant so to be prepared for financial
circumstances; there are times the ob
depending on the factor causes what, Sagittal View
vaginal but with the help of forceps or
vacuum - Anteroposterior is from the sacrum to the
- For anthropoid, vaginal but with the help of pubis (sagittal view)
forceps and sometimes it is NSVD, but the - Anteroposterior Diameters: 11 cm of the
position of the baby should be pelvic inlet considered adequate for vaginal
occipitoanterior or occipitoposterior. delivery
➔ The position of the babies should - The use of 3 conjugates is very important in
coincide with the type of pelvis that we the birthing process
are going to deliver - Pelvic inlet is considered adequate for
- For platypelloid, we have vaginal vaginal delivery if the measurement of their
spontaneous delivery, but the size of the fetal conjugates are as follows:
skull should be proportionate with the • True Conjugate: 4 3/8” (11cm) or
diameter or the measurements of the pelvic greater
cavity itself  Also called as the Anatomical
Conjugate
Pelvic Inlet Diameters and Measurements: • Diagonal Conjugate: 4 7/8” to 5 1/8”
- Pelvic inlet is in the true pelvis and the upper (12.5cm to 13cm)
part of the true pelvis • Obstetric Conjugate: 10 cm
Anteroposterior View Pelvic Outlet Diameters and
- Anteroposterior Diameters: 11 cm Measurements:
 From the pubis to the sacrum - Pelvic Outlet is considered as adequate for
(anteroposterior view) vaginal delivery if the following
- Transverse Diameter: 5 3/8 inches (13.5cm measurements are as follows:
or greater) • Anteroposterior Diameter: 4 5/8”
 From the ilium to the ilium of the pelvis (11.7cm)
- Oblique Diameter: 5 inches (12.7cm)  From sacrum or symphysis pubis to
coccyx
• Transverse / Intertuberous Diameter: 3
7/8” to 5 3/8” (10 to 13.5 cm)
 From left ischial tuberosity to the right
side of ischial tuberosity
• Posterior Sagittal Diameter: 3 ½ inches
(9cm)
 From this part here to the sacral iliac
joint
 Either left or right

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Fetal Skull
- Size is important as the fetus travels through
the birth canal
- Fetal skull is very important because this is
very significant during the labor and delivery
as we also check for any disabilities
- Fetal skull is some extent compressible and
made mainly of thin pliable tubular flat bones
- Contains 8 bones:
➔ 2 fused frontal bones
➔ 2 parietal bones
➔ 1 occipital bone
➔ Anchored to the rigid and incompressible
bones at the base of the skull

Soft Tissues
- Also play a role in labor and delivery
- The lower segment of the uterus expands to
accommodate the intrauterine contents as
the walls of the upper segment thicken - Other 4 bones of the skull:
- There are also a lot of factors which also ➔ Sphenoid
causes the intrauterine wall to soften and that ➔ Ethmoid
also aids the passage of the baby going out ➔ 2 temporal bones
- The cervix is drawn up and over the - The bones meet at suture lines composed of
presenting part as it descends strong, flexible, fibrous tissue which allow the
- The Vaginal Canal distends to accommodate cranial bones to move and overlap, making it
the passage of the fetus possible for the skull to decrease in size

Passenger
- Refers to the fetal skull
- Refers to the fetus and its ability to move
through the passage and affected by several
fetal features:
• Presentation
• Attitude
• Station
- It is very important to know the type of
• Lie sutures of the skull because for example,
• Position during delivery or when the baby is delivered
you will experience conditions like caput
succedaneum, molding, cephalohematoma,
etc…
➔ You will determine that type of specific
condition by the determinants of these
suture lines

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
- Typically, the smallest diameter of the fetal - Posterior Fontanel
skull is the one that enters the pelvis first. ➔ Triangular shaped
- The head can flex and extend 45 degrees ➔ Formed by the junction of 3 suture lines
and rotate 180 degrees, which allows its (sagittal suture anteriorly and lambdoidal
smallest diameter to move down the birth suture on either side)
canal and pass through the maternal pelvis. ➔ Located at the juncture of occipital and
➔ During childbirth, the fetus will rotate on parietal bones
its own ➔ Measures about 0.5 to 1 cm across
➔ The fetus, while still inside, have instincts ➔ Closes on about 8 to 13 weeks
already when and where to turn ➔ Is membranous but becomes bony at
- Fetal skull is very important also because it term, thus truly its nomenclature as
has sutures fontanel is misnomer, it denotes the
position of the head in relation to the
Sutures – seams between the bones of the skull
maternal pelvis
- Coronal – Frontal and parietal
- Lambdoid – Occipital and parietal
- Sagittal – Two parietal bones
- Squamous – Parietal and temporal (can be
viewed in a lateral view)
- NOTE: These sutures fuse or they are the
ones that compresses the bones

Diameters of the Fetal Skull


Biparietal Diameter (9.25cm)
- Smallest diameter of the fetal skull
- Also called as “transverse diameter”
- When we say biparietal = 2 parietal are the
bones that are involved in the measurement
- Measure 9.25cm and it extends between 2
Fontanelles – Flexible fibrous tissue. parietal bones or eminences
- Whatever may be the position of the head,
- Gap between the suture lines this diameter nearly always engages
- Anterior Fontanel
➔ Diamond shaped Suboccipitobregmatic Diameter (9.5cm)
➔ Located at the juncture of the frontal and - Smallest anteroposterior diameter
parietal bones - Measured from the inferior aspect of the
➔ Measures 1 1/8 inch to 1 5/6 inches (3 to occiput to center of the anterior fontanelle
4cm) long and ¾ inch to 1 1/8 inch or 2 to - Bregma – forehead
3 cm wide - Occipito – occiput
➔ Formed by joining of the four sutures. (2 - Measure up to down
frontal bones and 2 parietal bones)
➔ Closes on about 12 to 18 months

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Occipitomental Diameter (13.5cm) Moderate Flexion
- Occipitofrontal Diameter presents in the
- Widest anteroposterior diameter birth canal
- Measured from the posterior fontanelle to the - One who presents during the birth that
chin refers to either the brow
- This diameter is usually what we are going to
see if the fetus or the baby is in full flexion
meaning good flexion Poor Flexion
➔ Because the chin of the baby will touch - When the head is hyperextended
the chest - Largest diameter
➔ What we are going to see is the - Occipitomental Diameter presents in the
birth canal
occipitomental or vertex part
Poor Flexion results to:

Factors of Unusual Fetal Position:


Degree of Flexion ➢ Small mother
- The degree of flexion is very important during ➢ The position of the baby is not very
the labor and delivery because this is where accurate during the delivery, so the baby
we can determine that the baby is or will pass would have a malposition which results to
the line passage or the maternal pelvis in poor flexion
➢ Small uterus
good condition
➔ The baby would curl up
Full Flexion ➢ Malformed fetus
- Fetal head flexes so sharply ➢ Uterine fibroids
- The chin rest on the chest ➢ Multiple fetus or gestation
- Smallest anteroposterior diameter and ➔ Example: The twin A is in a good
suboccipitobregmatic diameter is present position, and we can deliver the twin A
in the birth canal or the first baby successfully. During
- Type of Cephalic Presentation: Vertex that time na nabilin si twin B and will
➔ Most reliable presentation during suddenly malposition, this is the time
childbirth we can deliver it either cesarean
➔ We can have a normal delivery and
after that CS.
➔ We can also have both vaginally if both
the mother has a good pelvis
measurement and the baby’s position
is in good position or full flexion. (Both
baby)
➢ Large fetus
➢ Unusual placental site
➔ Example: If the baby has really a bad
position, the placenta could dislodge,
implant, block, etc…

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
➢ When the baby is really large, and the Fetal Attitude
mother’s pelvis is really small which could - Describes the degree of flexion a fetus
lead to cesarean delivery because we
assumes during labor and delivery or the
cannot deliver the baby through normal
spontaneous or NSVD relation of the fetal parts to each other.
- Review: During delivery, it is in relation of the
fetal parts

Molding
• Normal
• Overlapping of the skull bones along the
suture lines
• Changes in shape of the fetal skull to long
and narrow shape that facilitates passage
through the rigid pelvis
• Molding is also the alteration of the shape
of the fore coming head while passing
through the resistant birth passage during
the labor
➔ There is however very little alteration in Complete Flexion or Full Flexion in other books =
size of the head as a volume of the Vertex Presentation
content inside the skull is
Moderate Flexion = Military Presentation
incompressible, although small
amount of cerebrospinal fluid and • Ang bregma ang makita
blood can escape in the process
• During a normal delivery, usually an Poor Flexion (Extension) = Brow Presentation
alteration of 4 mm in the skull diameter
commonly occurs Full Extension = Face Presentation
• Only last a day or two Complete Flexion
• It is normal during delivery that mugawas • Good Attitude
ang tae because as the baby go outside, • The usual “fetal position” or the ideal one
the baby would compress the surrounding • Advantageous for birth because it helps
tissue or the soft tissue that is why it is also fetus presents the smallest anteroposterior
affected, and the baby would compress
diameter of the skull
the sigmoid colon. That is why the mother
• Occupies the smallest place possible
would poop during the delivery.
Example:
Molding results into that kind of shape kay sige ug Moderate Flexion
push ug balik ang mother. • Chin is not touching the chest anymore
• “Military Position or Military Presentation”

Partial Extension
• Poor flexion
• It presents the brow of the head to the birth
canal
• “Brow Presentation”

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Complete Extension Fetal Presentations
• Full extension - The fetal body part that will be first to pass
• Unusual position through the cervix and be delivered
• It occurs when there is less or minimal - Determined by the fetal attitude, lie and
amount of amniotic fluid position
(oligohydroamnios or oligohydramnios)
- Affects the duration and the difficulty of labor
• The presentation is either the face or the
- Affects the method of delivery
chin
- Most affected part
Caput Succedaneum
Fetal Lie
- The relationship between the long - Cap goes across the suture lines
(cephalocaudal) axis of the fetal body to the - Boggy edematous swelling of the fetal scalp
long axis of a woman’s body - It usually disappears without treatment
- No pathological significance
Longitudinal Lie - Swelling and edema of the fetal scalp
- Classified as cephalic or breech Ayaw pag libog sa molding and caput succedaneum:
- Occur 96% of pregnancies
- Longitudinal lie could either be the head is - Molding = when the fetal bones that are
below or the head is above overlapping
- Cephalic Presentation - Caput Succedaneum = edema part of the
➔ When the head is below head or swelling
- Breech Presentation
Subgaleal Hemorrhage
➔ When the head is above
- This involves bleeding in the specific portion
of the head of the baby which is the
subgaleal space
- Bleeding in the subgaleal space
Cephalohematoma
- This involves the bleeding in the periosteum

Cephalic Presentation
- Head presents first
- Most common type of presentation:
Types of Cephalic Presentation:
Transverse Lie
1. Vertex
- Shoulder presentation 2. Brow
- When the lie is perpendicular to the mother’s 3. Face
axis ➔ Poor Flexion
- When the long axis of the mother is 4. Mentum (Chin)
perpendicular to the fetus ➔ Complete Extension

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Breech Presentation Complete Breech
- Buttocks or feet presents first Lie: Longitudinal or vertical
- The presenting part for a breech presentation Presentation: Breech (sacrum and feet
is the sacrum presenting)
Presenting Part: Sacrum (with feet)
Types of Breech Presentation: Attitude: General Flexion
1. Complete
2. Frank Shoulder Presentation
3. Footling Lie: Transverse or horizontal
a. Could be Single Leg Presentation: Shoulder. Could also be the elbow
b. Could be Double Leg or the knees
Presenting Part: Scapula or the angel wings in the
bones
Attitude: Flexion

- Presenting part is the shoulder, iliac crest,


hand and elbow, fetus is lying horizontally
in the pelvis
- The mother is vertical while the baby is
horizontal
➔ This is called perpendicular
Causes:
- Relaxation of the abdominal walls
- Pelvic contraction
- Placenta previa
- Polyhydroamnios or Polyhydramnios
➔ There are a lot of fluid that is made up
in the abdominal wall of the mother and
it could lead into a lot of turning of the
baby

Frank Breech
Lie: Longitudinal or vertical
Presentation: Breech (incomplete)
Presenting Part: Sacrum
Attitude: Flexion, except for legs at knees

Single Footling Breech


Lie: Longitudinal or vertical
Presentation: Breech (incomplete)
Presenting Part: Sacrum
Attitude: Flexion, except for one leg extended at
hip and knee

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Fetal Position Four (4) Landmarks to Describe the Presenting
- Relationship of the presenting part to the Part to One of the Pelvic Quadrants:
specific quadrant or part and side of a 1. Vertex – Occiput
woman’s pelvis 2. Face – Chin (Mentum)
- Maternal pelvis is divided into 4 3. Breech – Sacrum
quadrants: 4. Shoulder – Acromion Process
1. Right Posterior
2. Left Posterior
3. Right Anterior
4. Left Anterior

-
LOA
- Most common fetal position
ROA
Four parts of the fetus are also chosen as - Second most common fetal position
landmarks: • Fetus born fastest on either position
1. Right occipitoposterior (ROP)
➔ Right part of the maternal pelvis
➔ Occiput for the fetus
➔ Posterior for the maternal pelvis
2. Left occipitoposterior (LOP)
➔ Left part for the maternal pelvis
➔ Occiput for the fetus
➔ Posterior part of the pelvis
3. Right occipitoanterior (ROA)
➔ Right side of the maternal pelvis
➔ Occiput for the fetus
➔ Anterior portion of the maternal pelvis or
quadrant
4. Left occipitoanterior (LOA)
➔ Left side of the maternal pelvis
➔ Occiput for the fetus
➔ Anterior portion of the maternal pelvis or
quadrant

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA


NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Engagement 7 Cardinal Movements
- Refers to the settling of the presenting part Acronym: EDFIREERE (to easily memorize)
of the fetus far enough into the pelvis that it
E – Engagement
rests to the level of the ischial spine,
midpoint of the pelvis. D – Descent
F – Flexion
I – Internal
R – Rotation
E – Extension
E – External
R – Rotation
E – Expulsion
The degree of engagement is established by a
vaginal examination:

• Floating
➔ Presenting part is not engaged
• Dipping
➔ Descending but not yet touched the
ischial spine
➔ Nagka anam anam ug ka us us ang ulo
sa baby

Station
- Refers to the relationship of the presenting
part of the fetus to level of the ischial spine

Power
- Refers to the extent of push that the mother
will exert during the delivery
- Third important requirement for successful
labor
- This is very important as it is the force that is
supplied by the fundus of the uterus and
implemented by uterine contractions, which
causes cervical dilatation and expulsion of
the fetus from the uterus
- As the mother felt the contraction, that is the
time that she is going to push.
- What will if dili pa contracted ang abdomen
unya mupush siya?
➔ It could result to laceration
 Magisi kay magpataka ug utong
MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA
NCM 107: Care of Mother, Child, Adolescent (Well-Client)
Uterine Contractions Psyche
- There are True Labor and False Labor - A woman’s psychological state which may or
inhibit labor
True Labor - It can be based on past experience as well
• Contractions are: as her present psychological state
➔ Regular
➔ Increase in intensity and duration with There are a lot of women nowadays, the
walking psychological problems increased after giving birth.
➔ Felt in lower back, radiating to lower Taas ang postpartum depression because it started
portion of abdomen in postpartum blues leads to postpartum psychosis
• Bloody Show and leads to postpartum depression.
• Dilatation and Effacement
• Fetus usually engaged - As a nurse, you need to orient, educate, and
give awareness especially to first time
mothers, single mothers, and for those
False Labor mothers who are not financially capable of
• Contractions are irregular having a kid, and also to multigravid.
• Often stop with walking (mawala ra diay
siya)
• Contractions felt in abdomen above
umbilicus (abdominal pain)
➔ But does not radiate in the back or vice
versa
• No change in cervix
• Fetus is ballotable

Leopold’s Maneuver
- Systematic method of palpation to determine
the fetal presentation and position
- Done as a part of physical examination
L1: Fundal Grip
- Findings: Fundal height and Fundal Content
L2: Umbilical Grip
- Findings: Fetal Back, Fetal Small Parts, and
Fetal Heart Tone
L3: Pawlick’s Grip or Pawlik’s Grip
- Determine if Cephalic or Breech
L4: Pelvic Grip
- Engaged or Floating

MODULE 2F: OBSTETRIC ANATOMY YUSON, DREA

You might also like