With each maternal contraction, the fetal head pushes down on the pelvic floor. The pelvic floor has a gutter shape with a forward and downward slope, encouraging the fetal head to rotate from the left or right occipito-transverse position a total of 90-degrees, to an occipital-anterior (occiput facing forward) position, to lie under the subpubic arch. In this position, the fetal skull has a smaller diameter which assists passage through the pelvis. When this occurs the fetal neck flexes (chin to chest) allowing the circumference of the fetal head to reduce to sub-occipitobregmatic (9.5cm). Engagement is identified by abdominal palpation, where the fetal head is 3/5 th palpable or less.Īs the fetus descends through the pelvis, fundal dominance of uterine contraction exerts pressure down the fetal spine towards the occiput, forcing the occiput to come into contact with the pelvic floor. The term engagement is referring to the widest part of the fetal head successfully negotiating its way down deep into the maternal pelvis. This is when the largest diameter of the fetal head descends into the maternal pelvis. Increased frequency and strength of contractions during labourĪs the head descends, it moves towards the pelvic brim in either the left or right occipito-transverse position (this means the occiput can be facing the left side or right side of the mother’s pelvis).Fundal dominance of the uterine contractions during labour.Braxton hicks in the late stages of pregnancy.In the primigravida this is likely to occur from 38 weeks gestation onwards, in a multigravida woman, this may not occur until labour is established. It should be noted that descent and engagement occur together, rather than as completely separate/distinct stages, so consider them as 2 parts of the same process/stage. Occipitofrontal (vertex, neutral flexion) is 11.0cm.Suboccipitobregmatic (vertex, flexed) is 9.5cm.It is also important to know how the circumference of the fetal head varies with different degrees of neck flexion: Fetal head diameter varies depending upon the degree of neck flexion However, when it gets closer to the pelvic outlet, the nature of the pelvic floor muscles encourages the fetal head to rotate from a transverse position to an anterior-posterior position, as the AP diameter is greater than the transverse diameter. Since the transverse diameter is greater than the antero-posterior (AP) diameter in the pelvic inlet, the widest circumference of the fetal head descends in a transverse position. Pelvic inlet Borders of the pelvic outlet To understand the mechanism of labour, you need some basic understanding of pelvic anatomy. You might also be interested in our premium collection of 1,000+ ready-made OSCE Stations, including a range of O&G stations ✨ Pelvic anatomy
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You can use the up arrows to get back to the top of this page.īoth of these programs allow you to edit the configuration file in a user-friendly, soundedit.zip (17 KB) - add and remove sounds from TTD's sound catalog.TTTools (Chris Becke's Transport Tycoon Internals page).dxmci.zip (3 KB) - use DirectMusic to play music, see the manual.SV2flip (resynch multiplayer savegames).TTDAlter Tips (how to make best use of it with.GRFTrans (translate vehicle names in the new vehicle sets).Custom in-game texts (translate TTDPatch's in-game messages).Registry Editor (manage Win-TTD's registry settings).Graphics Manager (manage the new graphics configuration files).Configuration Tools (edit TTDPatch's configuration.These are some files and utilities that are useful when playing with TTDPatch, or The more unlikely an outcome, the better the potential prize. 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