MECHANISM OF

NORMAL LABOUR


R.JAYAPREETHI
Mechanism of Labour: adaptation or
accomodation of the fetal head to the pelvic
cavity and ultimate delivery of the fetus involves
positional changes .
Cardinal Movements of Labour:
1. ENGAGEMENT
2. DESCENT
3. FLEXION
4. INTERNAL ROTATION
5. EXTENSION
6. RESTITUTION
7. EXTERNAL ROTATION
8. EXPULSION
3 FACTORS INVOLVED IN LABOUR
PELVIS
FETUS
UTERINE FORCES
Pelvis
Fetal skull
FETAL LIE
The relation of the long axis of the fetus to that of the
uterine ovoid
Longitudinal lie is found in 99% of labours at term
Longitudinal lie cephalic presentation
breech presentation

FETAL PRESENTATION
The presenting part is the portion of the body of the
fetus that is foremost in the birth canal
The presenting part can be felt on vaginal examination


CEPHALIC PRESENTATION
Head is flexedsharply vertex presentation
Partially flexed bregma presenting (sinciput
presentation)
Partially extended brow presentation
Head is extended sharply face presentation
ATTITUDE
Posture of the fetus folded on itself to
accommodate the shape of the uterus
Flexed head, thighs, knees &feet
The arms crossed over the chest
Face presentation extended concave
contour of the vertebral column
POSITION
The relation of an arbitrary chosen point of the
fetal presenting part to the four quadrants of
maternal pelvis
The chosen point
Vertex presentation occiput
Face presentation mentum
Breech presentation Sacrum
Each presentation has two positions Rt or Lt
Each position has 3 varieties : Ant, transverse,
post

MECHANISM OF LABOUR IN
VERTEX PRESENTATION

Vertex 95%

The fetus enters the pelvis in transverse or
oblique diameter
LOT 40%
ROT 20%
OP 20%
ENGAGEMENT
The greatest diameter of the head passes
through the pelvic inlet
In vertex presentation, when the engagement
occurs the lowermost portion of the vertex
would be at level of ischial spines
It may occur in the last few weeks of pregnancy
in primi , only after the commencent of labour in
multipara
the fetal head may be freely movable above the
pelvic inlet , referred to as floating head


The sagittal suture frequently is deflected either
posteriorly toward the sacral promontory or anteriorly
toward the symphysis - asynclitism.
If the sagittal suture approaches the sacral promontory,
more of the anterior parietal bone presents itself to the
examining fingers, and the condition is called anterior
asynclitism.
If, however, the sagittal suture lies close to the
symphysis, more of the posterior parietal bone will
present, and the condition is called posterior
asynclitism.
Anterior asynclitism
Naegele's obliquity
Normal synclitism
Posterior
asynclitism
Litzmann's obliquity
DESCENT
In nullipara engagement takes place
before the onset of labour & further
descent may not occur till the 2
nd
stage
In multipara descent begins with
engagement
It is gradually progressive till the fetus is
delivered

Descent is brought about by
(1) pressure of the intrauterine fluid,
(2) direct pressure of the fundus upon the breech
with contractions,
(3) bearing-down efforts of maternal abdominal
muscles, and
(4) extension and straightening of the fetal body.
3-FLEXION
The descending head meets resistance
from either the pelvic floor or walls of the
pelvis
The shorter suboccipito-begmatic is
substituted for the longer occipito-frontal
diameter

Lever action producing flexion of the
head; conversion from occipitofrontal to
suboccipitobregmatic diameter
4-INTERNAL ROTATION
Here the occiput mover from the position
towards the symphysis pubis,Less commonly
towards the hollow of sacrum
In LOA or LOT positions it occurs from the left to
right
Occiput is forced into a gutter,formed by two
halves of the levator ani muscle which is in
downward and forward direction, by the effect of
the contraction and relaxation of the uterus.

T
Forward incline of the walls of pelvic
cavity
Impetus given by ischial spines
Effective uterine contraction

Internal rotation brings the diameter of
engagement to the longest of pelvic outlet
Transverse position ,occiput rotates
through 90
In anterior position 45
CROWNING
Max diameter of the head stretches the
vulvul outlet without any recession of the
head even after the contraction is over

EXTENSION
When the flexed head reaches the vulva it
undergoes extension the base of the
occiput will be in direct contact with the
inferior margin of the symphysis pubis
The head is born by further extension as
the occiput, bregma, forehead, nose,
mouth & chin pass successively over the
perineum

Extension results from two forces
Effect of uterine contraction from above
and elastic resistance of the pelvic floor
below
RESTITUTION
After delivery of the head it returns to the
position it occupied at engagement ,
Neck is untwisted, chin rotates towards
right side in LOA position
EXTERNAL ROTATION
After the untwisting of the neck next movement
is the internal rotation of shoulders,Then the
fetal body will rotate to bring one shoulder
anterior behind the symphysis pubis (
bisacromial diameter into the APD of the pelvic
outlet)
EXTERNAL ROTATION of the head occurs
simultaneously with this movement
EXPULSION
Once the shoulders rotated into AP
diameter of the outlet ,descent
continues wit uterine contractions until
ant shoulder hitches under the sym
pubis &post shoulder sweeps over
perineum
By lateral flexion of the fetal body
the post shoulder will be delivered &
the rest of the body will follow