5 P's of Labor

5 P’s OF LABOR: INTRODUCTION      Fetal lie: relationship of the spine of the fetus to the maternal spine. Passenger Passageway Powers Position Psyche Passenger -position of the fetus Fetal attitude: describes the relationship of fetal parts to each other. It is mainly visible in the amount of flexion in the fetal body. (not entire fetal body but the relationship of the chin or the mentum to the chest). -the more flexed, the closer the chin is tho the chest. Fetal Attitude- flexion The more flexed the fetal head, the smaller the diameter as it passes through the pelvis. Require cesarian for not vertical lie Questions: 1. In fetal lie, what is it called if the spine of the fetus, and maternal spine, are aligned or going in the same direction? Ans: Vertical lie 2. Which of the following statements is correct about fetal attitude? Ans: All ans are correct a. Moderate flexion is when the face of the fetus is a little bit further away from its chest. b. Poor flexion is when the chin of the fetus is going from a mid position to an extended position. It is also called brow presentation. c. Complete flexion is when the chin and the chest of the fetus are close together. d. Hyperextended flexion may result in a face presentation. Fetal presentation: relationship of the presenting part of the fetus to the quadrants of the maternal pelvis. FETAL PRESENTATION TYPES: Vertex (Cephalic) Breech (bottom is coming first) Shoulder (shoulder is coming first) Fetal Vertex Presentation: -most ideal; head is coming first -when the baby comes through, the neck comes through pretty quickly right after the head and so there is less of a chance of any constriction around the neck. Fetal Breech Presentation: 3 types of Breech  Frank breech (flexion of the hips and knee joints; hips flexed; knee joints extended) *Concern: As the baby moves through the pelvis, all of the soft tissue are going to form around the baby which is great until legs come out and then we get the neck.So now we’re on the neck what’s going to happen to the soft tissue? The soft tissue actually could contract and end up contracting around the baby’s neck. So this is why a breech position for a vaginal delivery is not ideal.  Complete breech (hips and knee joints are flexed; feet are tucked up underneath the bottom. *the hips are flexed but so are the knees.; It actually creates space for guess what? The cord. So our concern about a complete breech is that there’s room for the cord to actually slip through. Now remember, the cord is the source of oxygen for the fetus until it’s delivered. So, having the cord come through and then be subjected to comprehension may actually cut off the oxygen supply to the baby before it comes out, which is not ideal.  Footling breech (easiest to remember because they’re feet involved and it’s in the title.; single footling or a double footling. *Even worse, whether it is a double footling with 2 feet or a single footling this way, there is lots of room in the pelvis for the cord to slip through. So this is the number one reason why. *Breech presentations are not ideal for vaginal deliveries and you may find that when some patients come in and it’s known they’re in the breech position, they will not be offered a vaginal delivery, they will proceed straight to a cesarean birth. Questions: 1. Which of the ff. statements about types of fetal presentation is NOT correct? a. Cephalic presentation means the bottom comes first. b. Shoulder presentation is when the fetus’ shoulder comes first. c. Vertex presentation is the ideal fetal presentation for a vaginal delivery. d. With breech presentation, the fetus’ bottom, legs and everything else comes first and takes up much more space than the fetal head. e. Vertex presentation is also called cephalic presentation. FETAL ANATOMY Sacrum: lower part of the spine; it’s a bony prominence and we will use this as a landmark. -The mentum (chin)and the occiput is the back part of the fetal head. -Sometimes depending on the view, we will actually be looking at the scalp or the skull of the fetus. Posterior fontanelle: Shaped like a triangle Sagittal suture: Can actually feel with your fingers Anterior fontanelle: Shaped like a diamond 3. Relationship of the presenting part to the pelvis, to the maternal pelvis. *which part of the maternal pelvis is the presenting part facing? -when doing this we’re looking at the bottom view. So imagine a patient in lithotomy position, they’re lying on their back and the provider is facing them. All these orientations are the patient’s orientation,not the provider’s so don’t get confused. *So the 1st letter A could meant that the presenting part is facing the anterior portion of the pelvis. *P means posterior and T means Transverse. (could be right or left) 1. Determining here is which side of the maternal pelvis the presenting part is facing. *we have 2 options: it could left or right. 2. Occiput, Mentum, Sacrum (breech) FETAL POSITIONSPASSENGER What part of the baby is coming through the pelvis first? It’s the head. Head in this position looks like it’s flexed. Look from the lithotomy view, you can’t see the face so that means the head is flexed. So we’re going to use the occiput as our landmark. *where is the occiput facing? It’s actually facing the anterior portion of the pelvis. I know we talked about right and left, but right now Clitus is not facing right or left. Clitus is facing straight anterior so we don’t need to determine right or left right now. So the occiput is in the anterior position. So the way we would report this is we say “This fetus is in the OA position”. *this is the best position for delivery. It’s facing the maternal right side of the pelvis. This position is right occiput and it is anterior side. So the way we would report this is right occiput anterior. Now, the position is transverse so if you look at the view on the opposite side, you’ll see that the sagittal suture is dividing the pelvis. Now we have right occiput transverse.