2nd STAGE.pptx....LABOUR STAGE.....easy..

GNM 3rd YEAR
B.SC (N) 4th YEAR

1. SECOND STAGE OF LABOUR MS. BEENA VAZA

2. 2 nd STAGE It is the stage of expulsion of the fetus . It begins with full cervical dilatation and ends with the delivery of the fetus . Duration : about 1 hour in primigravida and ½ hour in multipara.

3. PHASES IN 2 nd STAGE IN LABOUR PROPULSIVE : From full dilatation of cervix to fetal head touches the pelvic floor. EXPULSIVE : From mother has irrespectible desire to bear down and push until the baby is delivered.

4. SIGNS OF 2 nd STAGE OF LABOR Positive signs : Cervix does not felt in vaginal examination Probable signs : A) EXPULSIVE UTERINE CONTRACTION : Mother has strong desire of bear down. trickling of blood vaginal mucosa is stretched and lacerated while head pushes downward.

5. CONT… B) Membrane is ruptured C) POUTING AND GAPING OF THE ANUS : When head touches the pelvic floor, pouting and gaping of the anus are happened. Usually cervix dilated. D) Tenseness between anus and coccyx is occurred due to pressure of descending head on pelvic floor. E) Congestion and gaping of vulva F) Presenting part is appeared.

6. CONT… 3. IMPENDING SIGNS Nausea and retching Irritability and uncooperativeness Complaints of severe discomfort Please for relief

7. MECHANISM OF LABOUR OR MOVEMENT OF LABOUR The series of passive movement of the fetus in its passage through the birth canal is known as mechanism of labour.

8. CONT… Engagement of the head Descent Flexion Internal rotation Crowning of the head Extension of the head Restitution External rotation of head and internal rotation of shoulder Birth of shoulders and trunk

9. 1. ENGAGEMENT OF THE HEAD This is when the widest part of the fetal head descents into the maternal pelvis. Engagement is identified by abdominal palpation, where the fetal head is 3/5 th palpable.

10. 2. DESCENT In the primigravida, this is likely to occur from 38 weeks gestation onward, there is no practically descent in the first stage. Descent is encouraged by: Increased abdominal muscle tone Braxton hicks contractions in late stages of pregnancy Uterine contraction and retraction Bearing down efforts Straightening of fetal spine after rupture of membranes.

11. 3. FLEXION OF THE HEAD Flexion is necessary for further descent. As the fetus descents through the pelvis, fundal dominance of uterine contraction exerts pressure down the fetal spine towards the occiput, forcing the occiput to come into contact with the pelvic floor.

12. 4. INTERNAL ROTATION OF THE HEAD This is the forward turning of the part of fetus , occiput rotates forward. 5. CROWNING OF THE HEAD After internal rotation of the head further descent occurs until the occipital prominence escapes under the symphysis pubis and the head no longer recedes between uterine contractions.

13. 6. EXTENSION It is a movement by which flexion of the head is undone. Delivery of the head takes place by extension through “ couple of force” theory.

14. 7. RESTITUTION The turning of the head to untwisting of the neck that took place during internal rotation of the head is called restitution.

15. 8. EXTERNAL ROTATION OF THE HEAD When the uterine contraction takes place after the head is born, internal rotation of shoulders, a movement similar to the internal rotation of the head takes place.

16. 9. BIRTH OF SHOULDER AND TRUNK After the shoulders are occupied in antero-posterior diameter of the outlet, further descent takes place until the anterior shoulder escapes under the symphysis pubis, the posterior shoulder passes under the perineum and the rest of the trunk is born by lateral flexion.

17. MANAGEMENT OF 2 nd STAGE OF LABOUR Observation for labour progress Fetal condition Physical – Bladder care, bowel care, pain relief etc.. psychological care