Which of the following best describes the cardinal movements of the fetus during the second stage of labor?

Explanation

## Cardinal Movements of Labor **Key Point:** The cardinal movements of the fetus during the second stage of labor occur in a specific sequence that allows the fetus to navigate the maternal pelvis and emerge. ### The Seven Cardinal Movements (in order) 1. **Engagement** — Fetal head enters the pelvic inlet; biparietal diameter passes through the pelvic inlet 2. **Descent** — Progressive downward movement of the fetus through the pelvis 3. **Flexion** — Fetal chin touches the chest; reduces the presenting diameter (occipitofrontal to suboccipitobregmatic) 4. **Internal Rotation** — Fetal head rotates 45–90° to align with the pelvic outlet (occiput rotates anteriorly) 5. **Extension** — Head extends at the symphysis pubis; crowning occurs 6. **External Rotation (Restitution)** — Head rotates back 45° to align with fetal shoulders 7. **Expulsion** — Body delivers after head; anterior shoulder delivers first under symphysis pubis, followed by posterior shoulder **High-Yield:** The mnemonic **EDFIERE** is commonly taught, but the correct sequence is **EDFIERE** rearranged as: **E**ngagement → **D**escent → **F**lexion → **I**nternal rotation → **E**xtension → **E**xternal rotation → **E**xpulsion. **Mnemonic:** **"Every Dog Fears Internal Examination, External Examination, Expulsion"** — helps recall the seven movements in order: **E**ngagement, **D**escent, **F**lexion, **I**nternal rotation, **E**xtension, **E**xternal rotation, **E**xpulsion. **Clinical Pearl:** Failure of internal rotation (transverse arrest or persistent occiput posterior) is a common cause of prolonged second stage and may necessitate operative delivery.