Page 232 - Critical Maternity & Newborn Health Nursing

b. Head felt smaller: Palpation of the bitemporal diameter (8cm)

instead of biparietal diameter (9.5cm).

c. Deflexed head: the head slightly extended instead of complete

flexion.

C. Auscultation:

Fetal Heart Rate (FHS) heard away from midline near anterior

superior iliac spine.

D. Ultrasonography examination

1. Confirm the diagnosis.

2. Exclude congenital anomalies.

E. Vaginal Examination:

1. Early in labor: Due to non-engaged head.

a. Slow dilatation of the cervix,

b. a voluminous bag of forewater,

c. liability to premature rupture of the membranes and prolapsed

cord.

2. Late in Labor:

When the cervix is sufficiently dilated specially after rupture of the

membranes, the anterior fontanelle is felt anteriorly towards the

obturator foramen, while the posterior fontanelle is felt posteriorly

towards the opposite sacro-iliac joint.

Mechanism of Labor:

1- Normal Mechanism: Long anterior rotation (90%)

3 factors help long internal rotation:

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