Extension

Extension moves the occiput to the fetal back (Figure 6-7):

■ Occurs after the fetus has descended to the level of the maternal vulva

■ This descent brings the base of the occiput into contact with the inferior margin of the symphysis pubis, where the birth canal curves upward.

■ The fetal head is delivered by extension from the flexed to the extended position, thus curving under and past the pubic symphysis.

FIGURE 6-5. Descent.

(Reproduced,with permission,from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis & Treatment. Nor-walk, CT: Appleton & Lange, 1994:211.)

FIGURE 6-5. Descent.

(Reproduced,with permission,from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis & Treatment. Nor-walk, CT: Appleton & Lange, 1994:211.)

FIGURE 6-6. A. Anterior rotation of head. B. Modified Ritgen maneuver.

(Reproduced, with permission, from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis- & Treatment. Norwalk, CT: Appleton & Lange, 1994:212.)

FIGURE 6-6. A. Anterior rotation of head. B. Modified Ritgen maneuver.

(Reproduced, with permission, from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis- & Treatment. Norwalk, CT: Appleton & Lange, 1994:212.)

The anterior shoulder is the one closest to the superior portions of the vagina, while the posterior shoulder is closest to the perineum and anus.

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