Obstetrics and gynecology. Biomechanism of labor in anterior occipital presentation. Seven basic fetal movements during childbirth (the most important)

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Obstetrics and gynecology. Biomechanism of labor in anterior occipital presentation. Seven basic fetal movements during childbirth (the most important)

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13. Biomechanism of labor in anterior occipital presentation. Seven basic fetal movements during labor

The biomechanism of childbirth consists in the process of adapting the position of the fetal head when passing through various planes of the pelvis. This process is necessary for the birth of a child and includes seven successive movements. The domestic school of obstetricians distinguishes four moments of the mechanism of childbirth in the anterior view of the occipital presentation. These moments correspond to the 3rd, 4th, 5th and 6th movements of the fetus during labor.

Head insertion - this is the location of the head at the intersection of the plane of entry into the small pelvis. The normal insertion of the head is called axial, or synclitic. It is carried out at a perpendicular position of the vertical axis with respect to the plane of entry into the small pelvis. The sagittal suture is at approximately the same distance from the promontory and the pubic symphysis. For any deviation from the distance, the insertion will be considered asynchronous.

promotion. The first condition for the birth of a child is the passage of the fetus through the birth canal. If insertion of the fetal head has already occurred at the onset of labor (in primigravidas), progress can be observed before the start of the second stage of labor. In repeated births, advancement usually accompanies insertion.

head flexion occurs normally when the descending fetal head encounters resistance from the cervix, pelvic wall, and pelvic floor. This is considered the first moment of the biomechanism of childbirth (according to the domestic classification). The chin approaches the chest.

When bent, the fetal head presents its smallest size. It is equal to the small oblique size and is 9,5 cm.

With the internal rotation of the head, the presenting part is lowered. The turn is completed when the head reaches the level of the ischial spines. The movement consists of a gradual rotation of the occiput anteriorly towards the symphysis. This is considered the second moment of the labor mechanism (according to the domestic classification).

Extension of the head begins when the region of the suboccipital fossa (point of fixation) approaches the pubic arch. The back of the head is in direct contact with the lower edge of the pubic symphysis (support point), around which the head unbends.

When unbending, the parietal region, forehead, face and chin are sequentially born from the genital tract.

External rotation of the head and internal rotation of the body. The born head returns to its original position. The back of the head again takes first an oblique position, then moving to a transverse position (left or right). With this movement, the fetal torso rotates and the shoulders are installed in the anteroposterior size of the pelvic outlet, which constitutes the fourth stage of the birth mechanism.

Expulsion of the fetus. The birth of the anterior shoulder under the symphysis begins after the external rotation of the head, the perineum soon stretches the posterior shoulder. After the appearance of the shoulders, the baby is born quickly.

Author: Ivanov A.I.

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