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Toronto Notes 2019 Normal Labour and Delivery
The Cardinal Movements of the Fetus During Delivery
Obstetrics OB33
1. Head floating, before engagement
5. Complete extension
Figure 7. Cardinal movements of fetus during delivery
Adapted from illustration in Williams Obstetrics, 19th ed
2. Engagement, descent, flexion
3. Further descent, internal rotation
7. Delivery of anterior shoulder
4. Complete rotation, beginning extension
6. Restitution (external rotation)
8. Delivery of posterior shoulder
Analgesic and Anesthetic Techniques in Labour and Birth
• painoranxietyleadstohighendogenouscatecholamines,whichproduceadirectinhibitoryeffecton uterine contractility
Non-Pharmacologic Pain Relief Techniques
• reductionofpainfulstimuli
■ maternal movement, position change, counter-pressure, abdominal compression
• activationofperipheralsensoryreceptors
■ superficial heat and cold
■ immersion in water during labour
■ touch and massage, acupuncture, and acupressure ■ TENS
■ intradermal injection of sterile water
■ aromatherapy
• enhancementofdescendinginhibitorypathways
■ attention focusing and distraction ■ hypnosis
■ music and audio analgesia
■ biofeedback
Pharmacologic Methods (see Anesthesia and Perioperative Medicine, A27) • nitrousoxide(e.g.self-administeredEntonox®)
• narcotics(usuallycombinedwithanti-emetic)
• pudendalnerveblock
• perinealinfiltrationwithlocalanesthetic
• regionalanesthesia(epiduralblock,combinedspinal-epidural,spinal)
Fetal Monitoring in Labour
• seeonlineFetalHeartRateTutorial
Vaginal Exam
• membranestatus,asindicatedbyamnioticfluid(clear,pink,bloody,meconium) • cervicaleffacement(thinning),dilatation,consistency,position,application
• fetalpresentingpart,position,station
• bonypelvissizeandshape
• monitorprogressoflabouratregularintervalsanddocumentinapartogram
© Danielle Bader