Name the three parts of the pelvis.

True pelvis is made up of the pelvic brim, pelvic cavity, and pelvic outlet: - pelvic brim superior circumference forms the brim - pelvic cavity b/w brim and outlet; depth of 4cm; contains the colon, rectum, bladder, and some of the reproductive organs - pelvic outlet lower circumference; -->anatomical outlet formed by the lower borders of the bones together with the sacrotuberous ligament --> obstetrical outlet includes the narrow pelvic strait through which the fetus must pass; narrow pelvic strait lies between the sacrococcygeal joint, the two ischial spines, and the lower border of the symphysis pubis it's the space b/w the narrow pelvic strait and the anatomical outlet How does the typical female pelvis compare to the male pelvis? Compared to the male pelvis, females have: - a larger pelvic outlet - wider pubic arch - wider, more circular pelvic inlet

Name and describe the 4 types of pelves.

Gynecoid --> best type for childbearing; has a rounded brim and a subpubic arch of 90 Android --> resembles the male pelvis; brim is heart-shaped; transverse diameter is situated towards the back; sub-pubic angle is < 90 (cannot easily accomodate the biparietal diameter); ischial spines are prominent; favours an occipitoposterior position Anthropoid --> long, oval brim in which the anterioposterior diameter is longer than the transverse diameter; wide sub-pubic angle Platypelloid --> kidney-shaped brim in which the anteroposterior diameter is reduced and the transverse is increased

Name the main bones of the fetal skull.

- occipital bone at the back of the head - two parietal bones on either side of the skull - two frontal bones form the forehead or sinciput (fuse into a single bone by age 8) - two temporal bones on both sides of the head

Name the sutures of the fetal skull.

- lambdoidal suture separates the occipital bone from the two parietal bones - sagittal suture lies between the two parietal bones - coronal suture separates the frontal bones from the parietal bones (one temple to the other) - frontal suture runs between the two halves of the frontal bone (disappears in time)

Name the fontanelles of the fetal skull.

- posterior fontanelle (or lambda) is situated at the junction of the lambdoidal and sagittal sutures; closes by 6 weeks of age

- anterior fontanelle (or bregma) is found at the junction of the sagittal, coronal, and frontal sutures; closes by 18 months of age

Name the three landmarks (regions) of the fetal skull.

- occiput region lies b/w the foramen magnum and the posterior fontanelle (occipital protuberance is considered part of the sub-occipital region) - vertex region is bounded by the posterior fontanelle, the parietal eminences, and the anterior fontanelle - forehead/sinciput region extends from the anterior fontanelle and the coronal suture to the orbital ridges

What is moulding?
- moulding is used to describe the change in shape of the fetal head that takes place during its passage through the birth canal - alteration is possible because the bones of the vault allow a slight degree of bending and the skull bones are able to override the sutures - moulding is a protective mechanism and prevents the fetal brain from being compressed as long as it is not excessive, too rapid or in an unfavourable direction

What is attitude?
- used to describe the degree of flexion or extension of the head on the neck - determines which diameters will present in labour and therefore influences outcome - attitude should be one of flexion smallest diameter will be present labour will be most effective

What is presentation?
Refers to which anatomical part of the fetus is leading, that is, closest to the pelvic inlet of the birth canal.

What are the possible fetal presentations?

- presentations can be vertex, breech, shoulder, face, or brow --> vertex, face, and brow are all head or cephalic presentations - when the head is flexed, the vertex presents - when the head is fully extended (back), the face presents - when the head is partially extended, the brow presents

What is lie?
- the relationship between the long axis of the fetus and the long axis of the uterus/mother - can be longitudinal, oblique, or transverse - majority of cases, lie is longitudinal owing to the ovoid shape of the uterus - oblique refers to when the fetus lies diagonally across the long axis of the uterus - transverse refers to the fetus lying at right angles across the long axis of the uterus

What is station?

- the relationship between the presenting part of the baby -- the head, shoulder, buttocks, or feet -- and two parts of the mother's pelvis called the ischial spines; normally the ischial spines are the narrowest part of the pelvis; they are a natural measuring point for the delivery progress - If the presenting part lies above the ischial spines, the station is reported as a negative number from -1 to -5 (each number is a centimeter) - If the presenting part lies below the ischial spines, the station is reported as a positive number from +1 to +5 - The baby is said to be "engaged" in the pelvis when it is even with the ischial spines at 0 station.

What is the denominator?

- refers to the name of the part of the presentation, which is used when referring to fetal position - in vertex presentation, the occiput is the denominator - in breech presentation, the sacrum is the denominator - in face presentation, the mentum (chin) is the denominator - in brow presentation, no denominator is used - in shoulder presentation, acromion process is used as its denominator

What is position?
- the relationship between the denominator of the presentation and six points on the pelvic brim - anterior positions are more favourable than posterior positions because when the fetal back is at the front of the uterus it conforms to the concavity of the mother's abdominal wall and the fetus can flex more easily - in a vertex presentation: Left occipitoanterior (LOA) Right occipitoanterior (ROA) Left occipitolateral (LOL) Right occipitolateral (ROL) Left occipitoposterior (LOP) Right occipitoposterior (ROP) Direct occipitoanterior (DOA) Direct occipitoposterior (DOP)

What is caput succedaneum?

- edematous swelling as a result of pressure from the cervical os disappears spontaneously within 24 hrs - 72 hrs - most often seen on the portion of the head which presented first - swelling may or may not have some degree of bruising

What are the three principal diameters of the pelvis?

- transverse diameter - oblique diameter - anteroposterior diameter

What is the widest measurement of the pelvic brim? What does it measure

Transverse: 13 cm
What is the widest measurement of the pelvic cavity? What does it measure Tricksy! All diameters (anteroposterior, oblique, and transverse) measure 12 cm. What is the widest measurement of the pelvic outlet? What does it measure

Anteroposterior: 13 cm
What is the point in the mechanisms of labour when the baby's head rotates to fit through the anteroposterior diameter?

Internal Rotation
Name the six longitudinal diameters and two transverse diameters of the fetal skull and their measurements (in cm). Longitudinal: - sub-occipitobregmatic (SOB) = 9.5cm - sub-occipitofrontal (SOF) = 10cm - occipitofrontal diameter (OF) = 11.5cm - mentovertical (MV) = 13.5cm - sub-mentovertical (SMV) = 11.5cm - sub-mentobregmatic (SMB) = 9.5 cm Transverse: - biparietal = 9.5 cm - bitemporal = 8.2 cm

What determines which diameters will present in labour?

Attitude of the head

How do you determine which diameters are presenting?
The presenting diameters are those that are at right angles to the curve of Carus. There are always two, a longitudinal diameter and a transverse diameter.

What is the curve of Carus?

"Such is Carus's curve which is the bent axis of the pelvic canal an important item of midwifery knowledge one without which a practitioner is incompetent scientifically to deliver a placenta and far less to extract a child by turning or to apply and deliver with the forceps or the crotchet I caution the Student not to fail in understanding this point very perfectly If he should make himself perfectly familiar with this curve of Carus I see not how he could make any mistake as to the appropriate direction of his efforts in any act of delivery whether with the hand alone or with instruments." (from Obstetrics: the science and the art By Charles Delucena Meigs, 1852)

What do the presenting diameters determine?

The presentation of the fetal head.