Managing Complications in Pregnancy and Childbirth: - IAWG

Normal labour and childbirthC-63• If necessary, a vaginal examination may be used to assess descentby relating the level of the fetal presenting part to the ischial spinesof the maternal pelvis (Fig C-5, page C-62).Note: When there is a significant degree of caput or moulding,assessment by abdominal palpation using fifths of head palpable ismore useful than assessment by vaginal exam.FIGURE C-5Assessing descent of the fetal head by vaginalexamination; 0 station is at the level of the ischial spine(Sp).PRESENTATION AND POSITIONDETERMINE THE PRESENTING PART• The most common presenting part is the vertex of the fetal head. Ifthe vertex is not the presenting part, manage as a malpresentation(Table S-12, page S-73).• If the vertex is the presenting part, use landmarks on the fetal skullto determine the position of the fetal head in relation to thematernal pelvis (Fig C-6).FIGURE C-6Landmarks of the fetal skull