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MECHANISM OF NORMAL LABOUR / CARDINAL MOVEMENTS OF LABOUR

DEFINITION
As the fetus descends, soft tissue and bony structures exert pressures which lead to
descent through the birth canal by a series of passive movements collectively these movements
are called as Mechanism of labor.

PRINCIPLES
 Descent takes place throughout the labor.
 Whichever part leads and first meets the resistance of the pelvic floor will rotate forwards
until it comes under the symphysis pubis.
 Whatever emerges from the pelvis will pivot around the pubic bone.

CHARECTERISTICS
 Lie is longitudinal
 Attitude is one of the good flexion
 Presentation is cephalic presentation
 Position is left occipito anterior
 Denominator is the occiput
 Presenting part is the posterior part of the anterior parietal bone
 Occiput points in right ileo pectineal eminence
 Sagittal sutures lies in right oblique diameter
 Presenting diameter is suboccipito frontal diameter 10cm
 Shoulders lies in left oblique diameter

MAIN MOVEMENTS

1) Descend:
 In primi gravida it occurs during latter weeks of pregnancy
 It will be aided by
 Forces of uterine contraction and retraction
 Rupture of fore waters
 Full cervical dilatation
 Maternal efforts speeds progress
 Slope of the pelvic floor muscle

2) Flexion:
 This increases throughout the labor
 Because of uterine contraction, fetal axis pressure will be exerted more on the occiput
than the sinciput causing good flexion
 Because of flexion the suboccipito frontal 10cm is reduced into suboccipito bregmatic
9.5cm
 The occiput is the leading part

3) Internal rotation of the head:


 Because of gutter – shaped and slope of pelvic floor gives resistance
 The slope of the pelvic floor determines the direction of rotation
 The second principle applied. The occiput is the leading part and meets the pelvic floor
resistance and it will rotate 1/8 of the circle forward until it comes under the symphysis
pubis.
 Because of internal rotation there is a twist at the neck.
 The sagital suture move from right or left oblique to Antero – posterior diameter
4) Crowning:
 The occiput slips beneath the sub-pubic arch and crowning take place
 The presenting part engages the vaginal outlet and it will not recede backward.
 The sub-occipito bregmatic diameter 9.5cm distends the vaginal outlet.

5) Extension of the head:


 Once crowning occur fetal head can extend
 Third principle applied
 The fetal head pivot around the the pubic bone
 This releases sinciput, face and chin sweeps the perineum and born by a movement of
extension.
 The suboccipito frontal diameter 10cm distends the vaginal outlet

6) Restitution:
 The occiput moves one-eighth of a circle towards the side from it started
 Because of this the twist in the neck of the fetus which resulted from internal rotation is
now corrected by a slight un twisted movement

7) Internal rotation of the shoulder:


 Now the shoulder is the leading part which meets the pelvic floor resistance
 Again second principle applied
 So from oblique diameter it will turn to Antero – posterior diameter

8) External rotation of the head:


 The head rotate in same direction as restitution and the occiput of the fetal head
now lies laterally

9) Lateral flexion:
 Anterior shoulder deliver by downwards and backward movement and posterior shoulder
deliver by upward and forward movement
 Body will be delivered by lateral flexion