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©2013 UpToDate ® Print Email The fetus emerges spontaneously (A), while uterine contractions maintain cephalic flexion Premature aggressive traction (B) encourages deflexion of the fetal vertex and increases the risk of head entrapment or nuchal arm entrapment. Reproduced with permission from: Gabbe, SG, Niebyl, JR, Simpson, JL (Eds). Obstetrics: Normal and Problem Pregnancies, 4th ed, Churchill Livingstone New York 2003. Copyright © 2003 Elsevier.
©2013 UpToDate ® Print Email The fetus emerges spontaneously (A), while uterine contractions maintain cephalic flexion Premature aggressive traction (B) encourages deflexion of the fetal vertex and increases the risk of head entrapment or nuchal arm entrapment. Reproduced with permission from: Gabbe, SG, Niebyl, JR, Simpson, JL (Eds). Obstetrics: Normal and Problem Pregnancies, 4th ed, Churchill Livingstone New York 2003. Copyright © 2003 Elsevier. Delivery of the lower limbs After spontaneous expulsion to the scalpulae, external rotation of each thigh (A) combined with opposite rotation of the fetal pelvis results in flexion of the knee and delivery of each leg (B) Reproduced with permission from: Gabbe, SG, Niebyl, JR, Simpson, JL (Eds). Obstetrics: Normal and Problem Pregnancies, 4th ed, Churchill Livingstone New York 2003. Copyright © 2003 Elsevier. Delivery of the upper limbs A towel is wrapped around the fetus for better traction. When the scapulae appears under the symphysis, the operator reaches over the left shoulder, sweeps the arm across the chest (A), and delivers the arm (B). Reproduced with permission from: Gabbe, SG, Niebyl, JR, Simpson, JL (Eds). Obstetrics: Normal and Problem Pregnancies, 4th ed, Churchill Livingstone New York 2003. Copyright © 2003 Elsevier. Beginning delivery of the head Following delivery of the arms, the fetus is slightly elevated. The fetal face and airway may be visible over the perineum. Excessive elevation of the trunk is avoided. Reproduced with permission from: Gabbe, SG, Niebyl, JR, Simpson, JL (Eds). Obstetrics: Normal and Problem Pregnancies, 4th ed, Churchill Livingstone New York 2003. Copyright © 2003 Elsevier. Delivery of the head Often, delivery of the head is easily accomplished with continued expulsive forces from above, suprapubic pressure, and gentle traction. Cephalic flexion is maintained by pressure (heavy arrow) on the fetal maxilla (not mandible!) Reproduced with permission from: Gabbe, SG, Niebyl, JR, Simpson, JL (Eds). Obstetrics: Normal and Problem Pregnancies, 4th ed, Churchill Livingstone New York 2003. Copyright © 2003 Elsevier.