Manual removal of the placenta. The abdominal hand provides counterpressure on the uterine fundus against the shearing force of the fingers in the uterus

Graphic plot of cervical dilatation (in green) and descent of the fetal presenting part (in red) during labor. From Cohen WR, Friedman EA (eds): Management of Labor. Gaithersburg, MD, Aspen Publishers, 1983, p 13.

The four basic pelvic types. The dotted line indicates the transverse diameter of the inlet. Note that the widest diameter of the inlet is posteriorly situated in an android or anthropoid pelvis.

Pelvic outlet and its diameters

A, The absence of cervical effacement prior to labor. B, Cervix being progressively taken up into the lower segment of the uterus (approximately 50% effaced). C, Cervix fully taken up (i.e., cervix is completely effaced).

A, The absence of cervical effacement prior to labor. B, Cervix being progressively taken up into the lower segment of the uterus (approximately 50% effaced). C, Cervix fully taken up (i.e., cervix is completely effaced).

Figure 9-10 Mechanism of labor for a vertex presentation in the left occipitotransverse position. A, Flexion and descent. B and C, Continued descent and commencement of internal rotation. D, Completion of internal rotation to the occipitoanterior position followed by delivery of the head by extension

Mechanism of labor for a vertex presentation in the left occipitotransverse position. A, Flexion and descent. B and C, Continued descent and commencement of internal rotation. D, Completion of internal rotation to the occipitoanterior position followed by delivery of the head by extension.

Mechanism of labor for a vertex presentation in the left occipitotransverse position. A, Flexion and descent. B and C, Continued descent and commencement of internal rotation. D, Completion of internal rotation to the occipitoanterior position followed by delivery of the head by extension.

Mechanism of labor for a vertex presentation in the left occipitotransverse position. A, Flexion and descent. B and C, Continued descent and commencement of internal rotation. D, Completion of internal rotation to the occipitoanterior position followed by delivery of the head by extension.

Ritgen's maneuver. The fingers of the right hand, pressing posterior to the rectum, are used to extend the head while counterpressure is applied to the occiput by the left hand to allow a controlled delivery of the fetal head.

Delivery of the shoulders. A, Gentle downward traction on the head is applied to deliver the anterior shoulder. B, Gentle upward traction is used to deliver the posterior shoulder.

Delivery of the shoulders. A, Gentle downward traction on the head is applied to deliver the anterior shoulder. B, Gentle upward traction is used to deliver the posterior shoulder.

A, Mediolateral episiotomy. B, Midline episiotomy

A, Mediolateral episiotomy. B, Midline episiotomy.

A, Repair of a midline episiotomy. A taped sponge is placed in the upper vagina and a continuous locked 00 or 000 absorbable suture closes the vaginal epithelium from the apex to the hymeneal ring. B, Three interrupted sutures are used to close the deep perineal fascia (of Colles) and underlying levator ani muscles. The vaginal epithelial suture is brought below the skin into the subcutaneous tissue. C, The same continuous suture is used to close the superficial fascia down to the anal edge of the episiotomy. D, The same suture is used as a subcuticular stitch coming back to the hymeneal ring, where it is doubly tied. The sponge is then removed (this is very important).

A, Repair of a midline episiotomy. A taped sponge is placed in the upper vagina and a continuous locked 00 or 000 absorbable suture closes the vaginal epithelium from the apex to the hymeneal ring. B, Three interrupted sutures are used to close the deep perineal fascia (of Colles) and underlying levator ani muscles. The vaginal epithelial suture is brought below the skin into the subcutaneous tissue. C, The same continuous suture is used to close the superficial fascia down to the anal edge of the episiotomy. D, The same suture is used as a subcuticular stitch coming back to the hymeneal ring, where it is doubly tied. The sponge is then removed (this is very important).

A, Repair of a midline episiotomy. A taped sponge is placed in the upper vagina and a continuous locked 00 or 000 absorbable suture closes the vaginal epithelium from the apex to the hymeneal ring. B, Three interrupted sutures are used to close the deep perineal fascia (of Colles) and underlying levator ani muscles. The vaginal epithelial suture is brought below the skin into the subcutaneous tissue. C, The same continuous suture is used to close the superficial fascia down to the anal edge of the episiotomy. D, The same suture is used as a subcuticular stitch coming back to the hymeneal ring, where it is doubly tied. The sponge is then removed (this is very important).