The last cardinal movement of fetal head during normal labor is?

KPSC Staff Nurse - 2015

Obstetrics & Gynaecology

Easy

Appeared in: KPSC Staff Nurse - 2015

Explanation

External rotation is the final cardinal movement performed by the fetal head before the delivery of the body.
This movement occurs after the head is born and involves the head rotating to realign with the fetal shoulders, which are simultaneously rotating to pass through the pelvic outlet.
The complete sequence of cardinal movements is: Engagement → Descent → Flexion → Internal Rotation → Extension → Restitution/External Rotation → Expulsion.
Restitution is the initial part of this movement, where the head corrects the twist it underwent during internal rotation, followed by the full external rotation as the shoulders align.

Option A: Internal rotation is a crucial movement, but it occurs earlier in the labor process, before the head is delivered. Its purpose is to align the anteroposterior diameter of the fetal head with the wider anteroposterior diameter of the pelvic outlet.
Option B: Engagement is the entry of the fetal head's widest diameter into the maternal pelvis. It is one of the very first cardinal movements, not the last.
Option C: Extension is the movement where the fetal head pivots under the symphysis pubis, allowing the face and chin to be born. It occurs immediately before external rotation, not after.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Cardinal Movements of Labor as background academic context rather than a clinical decision trigger.
A thorough understanding of the cardinal movements is essential for nurses to accurately assess the progress of labor and identify any deviations from the normal process.
Failure to progress through these movements can indicate issues like cephalopelvic disproportion (CPD) or fetal malposition, requiring timely intervention.
What if? - If external rotation does not occur spontaneously after the delivery of the head, it is a critical sign of shoulder dystocia, an obstetric emergency. The nurse's immediate response should be to call for help, assist the mother into the McRoberts maneuver (hyperflexing her legs onto her abdomen), and prepare to apply suprapubic pressure as directed by the provider.

How to Approach the Question

First, identify the key term in the question: 'last cardinal movement of fetal head'. This directs you to recall a specific sequence of events.
List the cardinal movements of labor in their correct order: Engagement, Descent, Flexion, Internal Rotation, Extension, External Rotation, and Expulsion.
Analyze the sequence. Expulsion is the delivery of the entire body. The question specifically asks about the last movement of the fetal head.
Locate the final movement involving the head before the body is delivered. This is External Rotation (which includes restitution).
Compare this with the given options. 'External rotation' is listed as an option.
Eliminate the other options by placing them correctly within the sequence: Engagement is first, Internal Rotation is in the middle, and Extension precedes External Rotation.

Concept Tested & Keywords

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E6 Obstetrics Williams p. 21-39