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Cardinal Movements

There are 8 cardinal movements of the head in normal labour.

  • Every – Engagement (synclitic or asynclitic)
  • Decent - Descent
  • Female - Flexion
  • I - Internal rotation
  • Choose to - Crowning
  • Employ - Extension
  • Rises - Restitution
  • Extremely - External rotation

Mnemonic: Every decent Female I choose to Employ Rises Extremely.


Engagement can be:





When sagittal suture of the head of fetus lies in the transverse diameter of pelvic inlet (midway between the pubic symphysis and the sacral promontory)

It occurs in 25% cases



Sagittal suture is defected towards sacral promontory. Also k/a anterior parietal presentaion/Naegeles

obliquity. It occurs commonly in multipara



Sagittal suture is defected towards pubic symphysis, the posterior parietal bone thus becomes the leading part.

Also k/a Litzman obliquity/ parietal presentation

It occurs commonly in nulliparous



Causes of non-engagement of head in a nullipara at term:

  • Malpresentatlons? I Occipitoposterior postition/deflexed head
  • Cephalopelvic disproportion?
  • Placenta previa? / Tumours in the lower seqrnent?
  • Tumours of the fetal neckQ /Cord around the neckQJHydrocephalusQ
  • Polyhydramnios?
  • Distended bladder and rectum.?

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