External rotation can now occur to deliver or expel the rest of the body. The head is engaged and there is descent of the fetus. In this image you can see the head is applied to the cervix and the cardinal movements start. That fetus is going to expel the rest of its body out. Sometimes the physician will help to do this. So the head is delivered and it will rotate to realign its body. This movement ends with the head delivering. The face is aligned with the maternal rectum and extends its head. It will extend its neck so it is not chin to chest anymore to better get itself under those pelvis bones. So after internal rotation we have extension. So it is going to rotate itself around then extend itself. The fetus will then have internal rotation. If the fetus is higher up above the ischial spines then it is -1,-2 and so on. As the baby gets closer to delivery it will be lower which is measured in centimeters and described as +1, +2 and so on. This is discussed in the module on process of labor but basically you can see in this image that zero station means the fetus is at the ischial spines of the pelvis. Descent is spoken in terms of the station that the fetus is in. Flexion is that chin to chest to help the fetus move it’s way out. Now descent, so the fetus is moving further towards the “exit” and flexion of the head occurs. This can happen a few weeks before delivery and is also known as “lightening”. This is the head in the pelvis engaged in and not moving back up. These are the movements that the fetus does to find its way out. The mechanisms of labor are known as the cardinal movements. In this lesson I will explain how labor and the delivery occurs and your role in assisting the patient in a successful delivery. False: Contractions are not regular, do not get stronger or closer together, stop with rest, hydration, and activity.True: contractions can be timed regular, get stronger and closer together, do not stop with rest or activity.Amniotic fluid has a pH of 7-7.5 and will turn test strip blue.May need to perform Nitrazine test to determine if mother has urinated or ruptured membranes.Fetal head will be on cervix and will stimulate uterine contractions and therefore labor Absence of the buffer of the amniotic fluid in uterus.AROM: artificial rupture of membranes Done with a tool or hand of physician.ROM: spontaneous rupture of membranes at full term.Bacteria gets in because prolonged rupture.Greatest risk to baby occurs when this occurs before 37 weeks.PPROM: Preterm premature rupture of membranes.Estrogen and progesterone levels fluctuate, causing a fluid shift and subsequent weight loss of 2.2-6.6 kg approximately 24-48 hrs prior to labor.Burst of energy can occur 24-48 hrs before (“nesting”).Cervix gets ready by ripening, potentially dilating/effacing.Brown/blood tinged cervical mucus passes.Other events that occur just before labor occurs.False labor does not do any of the above.True labor produces dilation, effacement, engagement and descent.If mom changes activity (going from resting to walking) and the contractions stop, it is FALSE labor.True labor is progressive, regular, and becomes stronger.Restitution and external rotation : occur simultaneously as a fluid movement.
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