![]() Engagement usually occurs in an oblique position (left sacrum anterior, right sacrum. ![]() The bitrochanteric diameter descends obliquely with slight posterior asynclitisim ( the posterior buttock descends ahead of the anterior buttock, the intergluteal cleft is closer to the pubis than to the sacrum). The critical distance to keep in mind is a. Cardinal Movements of Labor Aug 7 A baby’s position is important for birth to proceed naturally, allowing the smallest part of the baby to present first. Cardinal movements of labor in breech birth. This distance corresponds with the true conjugate and is approximately 11 cm ( Figure 131-1A). The obstetric conjugate is the distance from the sacral promontory to a point on the inner surface of the pubic symphysis that is a few millimeters from the upper margin of the pubic symphysis ( Figure 131-1A). This distance represents the smallest diameter of the inlet and is normally 11 cm or more ( Figure 131-1A). Unfortunately, the ischial spine is difficult to define using ultrasound. The fetal head usually enters the birth canal transversely and engages in the pelvic inlet. The true conjugate can be estimated by subtracting 1.5 to 2 cm from the diagonal conjugate. For a fetus in occiput anterior position, the four cardinal movements of labor are flexion, internal rotation, extension, and external rotation. However, this measurement cannot be made clinically. The true conjugate, a radiographic measurement of the pelvic inlet, is the distance from the sacral promontory to the superior aspect of the pubic symphysis ( Figure 131-1A). To measure the diagonal conjugate place the tip of the middle finger at the sacral promontory and note the point on the hand that contacts the pubic symphysis ( Figure 131-1B). A normal diagonal conjugate measures approximately 12.5 cm, with the critical distance being 10 cm. The diagonal conjugate refers to the distance from the inferior border of the pubic symphysis to the sacral promontory ( Figure 131-1A).
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