Passenger:

Factors Affecting Labor

Fetal Head Size- cephalopelvic disproportion (CPD) baby's head or body is too large to fit through the mothers pelvis. Attitude-relationship of the fetal body parts to one and other (degree of flexion) Complete Flexion-most common; "the fetal position"; vertex presentation; chin touches the chest Moderate Flexion-second most common; "military position"; sinciput presentation; chin does not touch the chest Partial Extension-uncommon; brow presentation; can make birth difficult Complete Extension-relatively rare; face presentation; the occiput touches the fetuses upper back Lie-relationship of the fetal spine to the maternal spine

Longitudinal Lie fetal spine is parallel to maternal spine fetuses line vertically can be both cephalic or breach most common, about 99%

Transverse Lie fetal spine is 90 to maternal spine fetuses line horizontally

Oblique Lie fetal spine is 45 to maternal spine midway between longitudinal and transverse rare and considered abnormal

Position-relationship of the presenting part of the fetus to a specific quadrant of the mother's pelvis First Letter-which way the presenting part is facing Second Letter-the presenting part of the fetus Third Letter-which way the presenting part is lying in relation to maternal pelvis

Right Occipitposterior

Left Occipitposterior Labor tends to be longer and more painful

Right Occipitanterior Most common Duration of L&D shortest

Left Occipitanterior Most common Duration of L&D shortest

Presentation-the part of the fetus that presents into the birth canal first. Determine by attitude, lie, and position. Cephalic Fetal Presentation: Vertex parietal bones of the presenting part of the fetus considered optimal for fetal descent longitudinal lie with complete flexion attitude Brow & Sinciput Brow or forehead is the presenting part of the fetus longitudinal lie with moderate flexion attitude Face face is the presenting part of the fetus longitudinal lie with partial extension attitude severe edema and facial distortion occur from pressure of uterine contractions Mentum chin is the presenting part of the fetus longitudinal lie with partial extension attitude severe edema and facial distortion occur from pressure of uterine contractions vaginal delivery is usually impossible

Breech Fetal Presentation: Complete buttocks and feet are the presenting part of the fetus longitudinal lie with complete flexion attitude legs are crossed least difficult breech position

Frank buttocks are the presenting part of the fetus longitudinal lie with moderate flexion attitude both legs are drawn up

Footling Incomplete & Footling One or both of the knees and legs are the presenting part of the fetus longitudinal lie legs are extended with little or no hip flexion most difficult breech position cord prolapsed is common Other Fetal Presentation: Shoulder Shoulder, iliac crest, hand or elbow is the presenting part Transverse lie Ranges from complete flexion to complete extension In mulitparous it can be caused due to relaxation of the abdominal walls Other causes: pelvic contraction, placenta previa

Compound Extremity presents with another major presenting part (usually head) They present simultaneously