Cardinal movement occurs before expulsion is?

AIIMS Raipur - 2017 (Shift-3)

Obstetrics & Gynaecology

Easy

Appeared in: AIIMS Raipur - 2017 (Shift-3)

Explanation

The cardinal movements of labor follow a specific sequence: Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, and finally, Expulsion.
External rotation, also known as restitution, is the sixth movement in this sequence.
During external rotation, the delivered fetal head rotates to realign with the fetal shoulders, which are still inside the pelvis.
This movement immediately precedes the delivery of the shoulders and the rest of the body, which is termed expulsion. Therefore, external rotation is the cardinal movement that occurs just before expulsion.

Option A: Engagement is the first cardinal movement, where the fetal head enters the pelvic inlet. It occurs at the beginning of labor, long before expulsion.
Option B: Crowning is not a cardinal movement itself but rather a sign that occurs during the extension phase. It is when the widest part of the fetal head is visible at the vaginal opening. It happens before external rotation and expulsion.
Option C: Internal rotation is the fourth cardinal movement. It occurs when the fetal head rotates within the pelvis to align with the anteroposterior diameter of the outlet. This happens well before expulsion.

Visual 1: Diagram - An illustration showing the seven cardinal movements of labor in sequence, from engagement to expulsion. Each step should be clearly labeled to show the progression of the fetus through the birth canal.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain The concept tested is the sequence of the cardinal movements of labor, which are the positional changes the fetus undergoes to navigate the birth canal as background academic context rather than a clinical decision trigger.
Understanding the cardinal movements is crucial for nurses to assess the progress of labor accurately.
By recognizing the sequence, a nurse can anticipate the next stage of delivery, prepare the necessary equipment, and provide appropriate support to the mother.
Failure of a cardinal movement to occur can indicate a problem such as cephalopelvic disproportion or fetal malposition, requiring timely intervention.

How to Approach the Question

First, identify the core concept of the question, which is the 'cardinal movements' of labor.
The question asks for the specific movement that occurs immediately 'before expulsion'.
Recall the seven cardinal movements in their correct order: Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, Expulsion.
Locate 'Expulsion' in the sequence, which is the final step.
Identify the movement that comes directly before 'Expulsion'. This is 'External Rotation'.
Compare this with the given options and select the matching one.

Concept Tested & Keywords

Concept Tested: The concept tested is the sequence of the cardinal movements of labor, which are the positional changes the fetus undergoes to navigate the birth canal.
Stem keywords: Cardinal movement, expulsion
Lead-in keywords: occurs before

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