Dr.dr. Wawang S Sukarya, SpOG (K), MARS, MH.

Kes
What is labor?
What is labor?
The Passage
Pelvic Bones and Pelvimetry
The Passage
Pelvic Bones and Pelvimetry
Leopold Maneuver
Passenger: Attitude
Passenger: Presentation
MECHANISM OF NORMAL LABOR IN
OCCIPUT PRESENTATION
 Occiput or vertex presentation : 95%
 Cardinal movement of labor in occiput
presentation :
 engagement
 descent
 flexion
 internal rotation
 extension
 external rotation
 expulsion
 SYNCLITISM

 Posterior asynclitism (Litzman’s obliquity)

 Anterior asynclitism
 ENGAGEMENT

 The last few weeks

 Floating
 Enters the pelvic inlet
either in the transverse or in oblique
diameters
DESCENT :

Forces :
1. Pressure of the amniotic fluid
2. Direct pressure of the fundus upon the breech

3. Contraction of the abdominal muscles

4. Extension & straightening of the fetal body
FLEXION

 Resistance from the cervix/pelvic floor

 flexion of the fetal head

 Lever action  flexion  occipito
frontal  suboccipito bregmatic
diameter
INTERNAL ROTATION

 The occiput moves toward the symphysis

 The midpelvis, anterior diameter is little
longer than the transverse diameter
 The outlet is an anteroposterior oval as is
the fetal head
 Occiput is the presenting part
 The smallest resistance  in front
 EXTENSION

 The occiput  direct contact with

the inferior margin of the symphysis
pubis

 The vulvar outlet is directed upward

and forward
CHANGES IN SHAPE OF FETAL HEAD :

 Molding

 Caput succedaneum

 Cephalohematoma
THIRD STAGE OF LABOR

 Birth of placenta :

 Separation

 Expulsion
 SIGNS OF SEPARATION

 Gush of blood
 Lengthening of the umbilical cord
 Rising of the uterine fundus
 Uterus becoming firm & globular
 Schultze mechanism
 Duncan mechanism