Introduction to Passenger, Fetal Attitude, and Fetal Lie (Nursing)

00:00 The first P we're going to talk about is the passenger. Now specifically in this section, we want to talk about how the fetus is positioned in the uterus because it makes a difference in how it's going to come out. We talked in a previous lecture about the importance of the baby being compact. Because the more compact the baby is, the easier it is to slide through the pelvis and come out and be delivered vaginally. So let's look at what that means. There are 3 things we're going to specifically investigate to really understand that positioning of the fetus in the abdomen. Those 3 things are attitude, lie, and presentation. So let's start with attitude. Fetal attitude specifically describes a relationship of the fetal parts to each other.

00:52 It's mainly visible in the amount of flexion in the fetal body. Now, not the entire fetal body but the relationship of the chin or the mentum to the chest. So, the more flexed, the closer the chin is to the chest. So let's take a look. If we have complete flexion, what I want you to notice is that there is a lot of space in the lower graphic around the head so that means there's space for the baby to sort of wiggle round, which is ideal. So in this case, the chin and the chest are really close together and this is an example of complete flexion. So what happens when the head is less flexed. Look in the second graphic. What you'll notice is the chin is a little bit further away from the chest and if you look at that bottom graphic, the space around the head is now just a little bit less. So that means it's going to be a bit of a tighter squeeze in this particular situation. Now let's move to the next graphic and begin to see what poor flexion looks like. So now, the chin is going from being a mid position here to an extended position, almost like this, so the chin is lifted up. Alright. We call this a brow presentation because actually the brows are going to start to be visible and this is going to, again, contribute to less space for the baby to wiggle. So this is even worse than the previous position. Now let's look at a hyperextended flexion. So this is where the chin is all the way against and so I would be looking like this. Okay? So this is a full extension and this may result in a face presentation. So although that looks cute in the graphic, what you need to see is that there is the least amount of space around the baby's head. So this is going to be the most difficult position to try to deliver in. So that is what flexion looks like. We have complete flexion where the chin is to the chest, we have moderate flexion where we have a slight move away from the chest, poor flexion where we have a brow presentation and the head begins to be hyperextended, and full hyperextension we have a face presentation.

03:02 That is fetal attitude. Now, let's talk about fetal lie. This does not mean that the fetus is not telling the truth. This has to do with the relationship of the fetal spine to the pregnant patient's spine. So what do they look like and how do they intersect? There are 3 main ways that this could happen. Let's look at those. The first one is vertical. What you'll notice is that the fetal spine and the maternal spine are actually going in the same direction. Now this could be a situation where the baby is coming breech or the bottom is coming out first or head first. Either way, it's a vertical lie because the spines are going in the same direction. Now, let's see what happens if we get a little lean. So this is called an oblique lie and what you'll begin to see here is that the pregnant patient's spine is this way, but the fetal spine begins to turn. So it could turn to the left or right, the direction is not important but it's knowing that the spine is now not in line. This is called an oblique lie. Now just from the picture, you can see that coming through the pelvis is going to be much more difficult and really impossible in this position. The last fetal lie we're going to look at is a horizontal lie. Sometimes this is also called transverse, but we don't want to get you confused with some of the other positions we're going to look at later. So we're going to call it horizontal. So now we have a situation where the pregnant patient's spine is going this way, but the fetal spine is now perpendicular.

04:36 So it makes sort of a crust. So again, not possible for a vaginal delivery in this position. So if the baby does not adjust to a vertical lie, then a Caesarean birth is going to be required.