STUDENT NAME : NORDAYANA BINTI YUNUS (930912155146)

CLASS : ADMW 03/2020

MWNS4044 NORMAL MIDWIFERY
Normal Pregnancy: Feto-pelvic relationship
Exercise :
1.Define terms used in feto-pelvic relationship. (14 marks)
(a) Lie
- The lie refers to the relationship of the long axis of the fetus to the long axis of the
uterus. Majority case the lies are longitudinal due to the ovoid shape of the uterus
but also can be oblique or transverse.
(b) Attitude
- The relation of its different parts of the fetus to one another. The basic attitudes are
flexion, deflexion and extension.
(c)Presentation
- The part of the fetus that lies at the pelvic brim or in the lower pole of the uterus.
Presentation can be vertex, breech, shoulder, face or brow.
(d) Denominator
- is the name of the part of the presentation, which is used when referring to fetal
position.
(e) Position
- It is the relationship of the presenting part to the mother pelvis. Which expressed
by referring to the position of one of the areas of the presenting part known as
denominator.
(f) Presenting part
- The presenting part is defined as the lowermost part of the fetus to the part of
the fetus that exits the birth canal first which overlies the internal os and is felt
by the examining finger through the cervical opening which is vaginal
examination.
(g) Engagement
- Engagement means the descent of the biparietal diameter through the pelvic
brim. Which the head had passed the plane of the pelvic brim, and this said to
be engaged.

2. Explain in detail each term used in feto- pelvic relationship.

(a) Lie (3 marks)
- Lie in feto-pelvic relationship had 3 types:
1. longitudinal lie
- the long axis of the fetus is parallel to the long axis of the mother. Makes no
difference if the fetal head lies next to the cervix as shown in top diagram or
in the fundus as in the lower diagram. Occurs in more than 99% of full-term
pregnancies.
 2. oblique lie
- refers to when the fetus lies diagonally across the long axis of the uterus and
lie at a 45 degree angle between the long axis of the mother and is very
unstable.

3. transverse lie
- when the long axis of the fetus is perpendicular to the long axis of the mother.
Normal delivery is not possible, which if the fetus does not rotate
spontaneously an external cephalic version (ECV) may be attempted, if failed
the caesarean section will be indicated.
(b)Attitude (4 marks)
- Attitude is the posture of the fetus, which had 4 posture:
1. Flexion
- Lie in longitudinal and in cephalic presentation. Also in full flexion forms an
ovoid mass which corresponds to the shape of the uterine cavity. Fetus spine
curved slightly forward, head flexed with chin resting on chest, thighs flexed on
abdomen, calves flexed and crossed on thighs, arms flexed and crossed on
chest.
2. Deflexion
- Fetal lie in the longitudinal and the presenting part of the vertex is the parietal
bone.
3. Partial extension
- Fetus lie in longitudinal in cephalic presentation and the presenting part is the
brow shown partial extension attitude.
4. Extension
- Lie in longitudinal and in cephalic presentation and the presenting part is face.
Also, one or more parts are extended from the normal flexed position.

(c) Presentation (5 marks)

- five fetal presentation is:
1. Vertex
- The head is sharply flexed so that the chin is in contact with the chest and the
vertex is presenting which is the occiput or the back of the head.
2. Face
- When the neck is sharply extended to the occiput. Then occiput is in contact
with the back.
3. Brow
- Fetus in brow presentation has the chin untucked, and the neck is extended
slightly backward.
4. Breech
- There are 3 types of breech which are complete, incomplete and frank.
Complete breech showed both hips and lower extremities found in the lower
pelvis. While incomplete breech shown the fetus hips extended and one or
both feet in the lower pelvis. For frank breech the thigh flexed at the hips and
lower legs extended in front of the body and up in front of head.

5. Shoulder
 - shoulder presentation identifies when the fetus lies crosswise in the uterus. And
the presenting part is scapula (acromion process)

(d) Denominator (5 marks)

- denominator based on the presenting part:
1. in vertex presentation, the occiput is the denominator
2. in face presentation, the mentum (chin) is the denominator
3. in brow presentation, frontal eminence is the denominator
4. in breech presentation, the sacrum is the denominator
1. in shoulder presentation, acromion process is used as its denominator

(e) Position (8 marks)

- There 8 position in vertex presentation:
1. Left occipitoanterior (LOA)
- the occiput points to the left iliopectineal eminence. The sagittal suture is in the
right oblique diameterof the pelvis.
2. Right occipitoanterior (ROA)
- The occiput points to the right iliopectineal eminence. The sagittal suture is in
the left oblique diameter of the pelvis.
3. Left occipitolateral (LOL)
- The occiput points to the left iliopectineal line midway between the iliopectineal
eminence and the sacroiliac joint. The sagittal suture is in the transverse
diameter of the pelvis.
4. Right occipitolateral (ROL)
- The occiput points to the right iliopectineal line midway between the
iliopectineal eminence and sacroiliac joint. The sagittal suture is in the
transverse diameter of the pelvis.
5. Left occipitoposterior (LOP)
- The occiput points to the left sacroiliac joints. The sagittal suture is in the left
oblique diameter of the pelvis.
6. Right occipitoposterior (ROP)
- The occiput points to the right sacroiliac joints. The sagittal suture is in the right
oblique diameter of the pelvis.
7. Direct occipitoanterior (DOA)
- The occiput points to the symphysis pubis. The sagittal suture is in the
anteroposterior diameter of the pelvis.
8. Direct occipitoposterior (DOP)
- the occiput points to the sacrum. The sagittal suture is in the anteroposterior
diameter of the pelvis.
(f) Presenting part (2 marks)
- the part of the presenting which able to be felt by vaginal examination through
cervical opening. Thus, in cephalic presentation, the presenting part may be
vertex, face or brow, depending upon degree of flexion of the head. Similarly,
the fetal legs in breech presentation may be flexed, extended or a foot may
present. However, the term presentation dan presenting part are often used
synonymously.

(g) Engagement (3 marks)

 - biparietal diameter at pelvic inlet which presenting part at 0 station. Station is
the relationship of the presenting part to an imaginary line drawn across the
ischial spines. By manually palpating the fetal head and determining whether
the fetal is fixed or mobile and the head had passed the plane of the pelvic
brim, and this said to be engaged.

3. What do you understand about “lightening”? (2 marks)

- Lightening refers to the sensation that pregnant woman feels when the fetus
descends into the maternal pelvis. Few weeks prior to the onset of labour specially
in primigravida, the presenting part will sink into the true pelvis. Due to the active
pulling of the lower pole of the uterus around the presenting part. Which also called
“engagement” because the presenting part of fetus is then engaged in mother pelvis

4. What is the different between vertex presentation and cephalic

Presentation? (4 marks)
- Cephalic presentation is determined when the long axes of the fetus or the lie of the
fetus and mother are parallel, which the baby lie in longitudinal and the head enters the
pelvic brim first. Can be identified by abdominal palpation with obstetric grip (Leopold
maneuvers). While vertex presentation depends on the attitude of the fetus. Which the
normal attitude is full flexion, in this attitude every fetal joint is flexed. This gives a vertex
presentation, the only normal presentation. In vertex presentation, the position of one
area of the presenting part known as the denominator shown as occiput. Can examine
by vaginal examination which to identify a presenting part where cannot be identified
abdominally.

References
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Hanretty, K. P. (2010). Antenatal care - Abdominal examination. In Obstetrics illustrated (Seventh ed., pp.
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Sheth, S. S. (2011). Pelvis and fetal Skull - Fetopelvic Relationship (V. Sivanesaratnam, A. Chatterjee, &
P. Kumar, Eds.). In S. Arulkumaran (Ed.), Essentials of Obstetrics (Second ed., pp. 49-50). India: Jaypee
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Dutta, D. (2010). The Fetus-In-Utero. In H. Konar (Ed.), Textbook of Obstetrics (Seventh ed., pp. 75-80).
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Podder, L. (2019). Fundamentals of Midwifery and Obstetrical Nursing. New delhi, India:
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Kullabs Learning Simplified. (2017). Feto-Pelvic Relationship. Retrieved May 30, 2020, from
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Lopez-Zeno, J. A. (2020). Presentation and Mechanisms of Labor (P. V. Dadelszen, Ed.). Retrieved May
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Author: Physicians and Midwives. (2018, October 12). Which Way is Up? What Your Baby's Position
Means for Your Delivery: Physicians & Midwives ObGyn. Retrieved May 30, 2020, from
https://physiciansandmidwives.com/2012/11/15/what-your-babys-position-means-for-delivery/

Julien, S. (2017). Brow Presentation and Birth Injury (V. Berghella, Ed.). Retrieved May 30, 2020, from
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Wikipedia. (2020, March 12). Cephalic presentation. Retrieved May 30, 2020, from
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