Normal labour
Lie - longitudinal
Presentation - cephalic
Presenting part - vertex
Denominator - occiput
Position - left occiputo transverse position
Cardinal movements of labour
• Engagement
• Descent with flexion
• Internal rotation
• Extention
• Restitution
• External rotation
• Expulsion
Engagement
• When the greatest transverse diameter of the fetal head passes through the pelvic inlet,
the head is said to be engaged
• Biparietal diameter - 9.4cm
• When the head is engaged the leading bony point of the vertex is at or below the ishial
spine
• Time of engagement
• Primigravidae - before onset of labour (38 weeks)
• Multigravidae - at the onset of labour
• Clinical importance
• No cephalopelvic disproportion
Asynclitism
Anterior Asynclitism Posterior Asynclitism
When sagital suture
When sagital suture deflected towards pubic
deflected towards Sacral symphysis
promontory
Posterior parietal bone
can be felt in PV
Anterior parietal bone can be
felt in PV
As the head descends, it
meets resistance from the
pelvic walls and floor and
this leads to increased
flexion of the head.
As the head flexed it brings
the shortest longitudinal
diametre of the head -
suboccipitobregmatic -
9.5cm
to pass through the birth
It brings the occipital towards the
pubic symphysis
Aligns Suboccipitobregmatic
diameter with anterioposterior
diameter
It is essential for normal delivery to
occur
The occiput lies underneath the
Pelvic arch
Biparietal diameter
stretches the vulval outlet.
Head extend gradually
Occiput
Bregma
Born
Nose. Sequentially
Mouth
Chin
*Untwisting of neck
*Internal rotation of shoulder
is manifested by external
rotation of head
