COMPONENTS OF LABOR

PASSAGE
The

passage refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum

Two pelvic measurements:

The

diagonal conjugate(the anteroposterior diameter of the inlet)- it is the narrowest diameter at the pelvic inlet Transverse diameter of the outlet- it is the narrowest diameter at the outlet

PASSENGER
The

passenger is the fetus The body part of the fetus that has the widest diameter is the head Whether a fetal skull can pass depends on both its structure(bones, frontanelles, and suture lines) and its alignment with the pelvis

STRUCTURE OF THE FETAL SKULL

Cranium- uppermost portion of the skull, is composed of 8 bones > 4 superior bones- frontal, 2 parietal, and occipital > other 4 bones of the skull- sphenoid, ethmoid, and 2 temporal bones lie at the base of cranium The chin, referred to by its Latin name mentum, can be a presenting part

 Sagittal

suture joints-2 parietal bones of the skull Coronal suture- line of juncture of the frontal bones and the 2 parietal bones Lamboid suture- line of juncture of the occipital bone and the 2 parietal bones.

Frontanelles-

significant membrane- covered spaces, found at the junction of the main suture lines

> anterior frontanelle(bregma)- lies at the junction of the coronal and sagittal sutures - diamond shaped - its anteroposterior diameter measures approximately 3 to 4 cm; its transverse diameter, 2 to 3 cm, closes when infant is 12 to 18 months of age

> posterior frontanelle- lies at the junction of the lamboidal and sagittal sutures - triangular shaped - smaller than the anterior frontanelle

Vertex-

space between the two frontanelles Sinciput- area over the frontal bone Occiput- area over the occipital bone

DIAMETERS OF THE FETAL SKULL

The

diameter of the anteroposterior skull depends on where the measurements is taken. The narrowest diameter (approximately 9.5 cm) is from the inferior aspect of the occiput to the center of the anterior frontanelle

 The

occipitofrontal diameter, measured from the occipital prominence to the bridge of the base is approximately 12 cm The occipitomental diameter(approximately 3.5 cm) is measured from the posterior frontanelle to the chin

 The

anteroposterior diameter of the pelvis, a space approximately 11 cm wide, is the narrowest diameter at the pelvic inlet So to be born easily, a fetus must present a parietal diameter, the narrowest diameter(approximately 9.25 cm)

 At

the outlet, the fetus must rotate to present the narrowest fetal head diameter to the maternal transverse diameter, a space approximately 11 cm wide

 If

a fetus presents the anteroposterior diameter of the skull to the anteroposterior diameter of the inlet, engagement, or settling of the fetal head into the pelvis, may not occur

DEGREE OF FLEXION OF THE FETAL HEAD

a fetal head flexes so sharply the hin rests on the chest, and the smallest anteroposterior diameter, the suboccipitobregmatic, is presented to the birth canal

Full
Flexion

Moderate Flexion

the occipitofrontal diameter will be presents the largest diameter will present

Poor Flexion

>

it follows a fetal head presenting a diameter of 9.5 cm will fit through a pelvis much more readily than if the diameter is 12.0 to 13.5 cm

MOLDING
A

change in the shape of the fetal skull produced by the force of uterine contractions pressing the vertex of the head against the notyet- dilated cervix Molding is commonly seen in infants after birth

 The

overlapping of the sagittal suture line and, generally, the coronal suture line can be easily palpated in the newborn skull No skull molding occurs when a fetus is breech, because the buttocks, not the head, are presented first

POWERS OF LABOR
UTERINE CONTRACTIONS Origins- labor contractions begin at a pacemaker point located in the uterine myometrium near one of the uterotubal junctions

In some women, contractions appear to originate at the lower uterine segment rather than in the fundus. These are reverse, ineffective contractions, and they may actually cause tightening rather than dilation of the cervix Some women seem to have additional pacemaker sites in other portions of the uterus. If so, contractions can be uncoordinated

3 Phases
Increment-

when the intensity of the contraction increases Acme- when the contraction is at its strongest Decrement- when the intensity decreases

 Between

relaxes As labor progresses, the relaxation intervals decrease from 10 minutes early in labor to only 2 to 3 minutes The duration contractions also changes, increasing from 20 to 30 seconds to a range of 60 to 90 seconds

contractions, the uterus

Contour Changes
As

labor contractions progress and become regular and strong, the uterus gradually differentiates itself into 2 distinct functioning areas: > the upper portion becomes thicker and active, preparing it to be able to exert the strength necessary to expel the fetus when the expulsion phase of labor is reached

> the lower segment becomes thin walled, supple, and passive, so that the fetus can be easily pushed out of the uterus As these events occur, the boundary between the two portions becomes marked by a ridge on the inner uterine surface, the physiologic retraction ring

CERVICAL CHANGES
Effacement-

shortening and thinning of the cervical canal Normally, the canal is approximately 1 to 2 cm long With effacement, the canal virtually disappears In primaras, effacement is accomplished before dilatation begins

 In

multiparas, dilatation may proceed before effacement is complete Dilatation- refers to the enlargement or widening of the cervical canal from an opening a few millimeters wide to one large enough(approximately 10 cm) to permit passage of a fetus

Dilation occurs for 2 reasons:

Uterine contractions gradually increase the diameter of the cervical canal lumen by pulling the cervix up over the presenting part of the fetus The fluid- filled membranes press against the cervix. If the membranes are intact, they push ahead of the fetus and serve as an opening wedge. If they are ruptured, the presenting part serves this same function

Psyche
Woman

s psychological outlook, refers to the psychological state or feelings that a woman brings into labor