2.

Passenger
Presentation

 Denotes the body part that will first contact the cervix or be born first
 Determined by the combination of fetal lie and the degree of fetal flexion (attitude)

1. Cephalic (vertex, brow, face, mentum) – most frequent type of presentation. Vertex is
the ideal presenting part because the skull bones are capable of effectively molding to
accommodate the cervix. Take note: in cephalic presentation the area of the skull
that contacts the cervix often becomes edematous that is why it will result to
caput succedaneum or the cone-shaped head of the baby the

2. Breech (buttocks or feet)- this type of presentation can cause a difficult birth.
There are three types of breech presentation:
 Frank bridge it is when the baby's legs are folded flat up against his head
and his bottom is closest to the birth canal.
 While in complete breach it is when both of the baby's knees are bent and
his feet and bottom are closest to the birth canal.
 In a footling breach as what you can see one or both feet are the
presenting parts during delivery.
 3. Shoulder (one of the shoulder, iliac crest, a hand or an elbow)

Take note that in this type of presentation, the fetus lies horizontally in the pelvis.The
contour of the mother's abdomen at term may appear fuller side to side rather than top
to bottom. Again, in shoulder presentation the fetus lies horizontally and to compare it
with the previous presentations we discussed like in cephalic presentation or breach
presentation the fetus lies longitudinally or vertically with respect to the position of the
mother's pelvis. In this type of presentation or in shoulder presentation, the presenting
part is usually one of the shoulders, an iliac crest, a hand or an elbow.

Another factor related to the passenger which has relevance to labor and delivery
is the fetal position.

Fetal position refers to the relationship of the presenting part to a specific quadrant and
side of a woman's pelvis.

An example of a fetal position is ROA or right occipitonterior.

Fetal Position
 important because it can influence both the process and efficiency of labor
 a fetus that is positioned in an ROA or LOA position is born fastest
 Remember: labor can be extended if position of the fetus is posterior
(meaning the position is in left occipitoposterior or right occipitoposterior and
this may be more painful for a woman because the rotation of the fetal head
puts pressure on sacral nerves.

Nursing intervention: place a woman in sims position on the same side of

Another factor related to the passenger which is very essential during labor and
delivery is engagement.

Engagement
 refers to the settling of the presenting part of a fetus far enough into the
pelvis that it rests at the level of the ischial spines, which is considered as the
midpoint of the pelvis
 in primipara, non-engagement of the fetal head at the beginning of labor
suggests that a possible complication such as an abnormal presentation or
position, abnormality of the fetal head, or cephalopelvic disproportion exists
 in multipara, engagement may or may not be present at the beginning of labor.
 Thus, if your patient is primipara you need to assess for the engagement of the
presenting part. At the beginning of labor and in a multipara patient, if and when
the presenting part is not yet engaged at the beginning of labor, it is still
considered as normal. Take note that the degree of engagement is established
by a vaginal and cervical examination.
 During documentation, you will document it as engaged when the presenting
part already rests at the level of the ischial spine and
 you will document it as floating when the presenting part is not engaged or
presenting part is descending but has not yet reached the ischial spines may be
referred to as dipping

Station
 refers to the relationship of the presenting part of the fetus to the level of the
ischial spine
  when the presenting part is at the level of the ischial spine, it is at station zero or
zero 0 station (this one is synonymous with engagement because we mentioned
earlier that the fetus has engaged or is already engaged when the presenting
part already rests on the ischial spine). So again, when the presenting part is
already at the level of the ischial spine, it is considered as station 0 or 0 station
but if the presenting part is above the ischial spine, the distance is measured and
described as minus stations or the negative ones which ranges from negative
one (-1) to negative four (-4).
 On the other hand, if the presenting part is below the ischial spines the distance
is stated as plus + stations. Take note that when we are talking about already of
plus three (+3) or plus four (+4) stations, the presenting part is at the perineum
and can be seen if the vulva is separated.

Effective passage of a fetus through the birth canal involves not only position and
presentation but also a number of different position changes. In order to keep the
smallest diameter of the fetal head, always presenting to the smallest diameter of the
pelvis. This position changes are termed as the cardinal movements of labor which
includes:

 descent
 flexion
 internal rotation
 extension
 external rotation
 expulsion

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