Management of 2nd stage of labour

normal labour

2. Series of events that takes place in the genital
organs in an effort to expel the viable
products of conception out of the womb
through the vagina into the outer world is
called labour

3. The second stage is that of expulsion of the
fetus. It begins when the cervix is fully
dilated and the woman feels the urge to
expel the baby. It is complete when the baby
is born.

4. Its average duration is 2 hours in primigravidaeand
30 minutes in multiparae.
Second stage has two phases:
Propulsive
Expulsive

5. Pain
Bearing down efforts
Membrane status
Descent of the fetus
Vaginal signs
Maternal signs
Fetal effects

6. Principles of mechanism of labour
Descent takes place throughout labour.
Whichever part leads and first meets the
resistance of the pelvic floor will rotate
forward until it comes under the symphysis
pubis
Whatever emerges from the pelvis will pivot
around the pubic bone.

7. Principal movements are:
Engagement
Descent
Flexion
Internal rotation
Crowning
Extension
Restitution
External rotation
Expulsion of the trunk.

15. Principles
To assist in the natural expulsion of the fetus
slowly and steadily
To prevent perinealinjuries

16. General measures
The patient should be in bed
Constant supervision
To administer analgesics
Vaginal examination

17. Preparation for delivery
Positioning.
Nurse and obstetrician scrubs up and puts on
sterile gown, mask and gloves
Toileting the external genitalia and inner side
of the thighs
One sterile sheet is placed beneath the
buttocks of the patient and one over the
abdomen. Sterilized leggings are to be used.
Essential aseptic procedures are remembered
as 3C’s: clean hands, clean surfaces, clean
cutting and ligaturing of the cord.
To catheterize the bladder, if it is full.

18. Conduction of delivery
3 phases:
Delivery of the head
Delivery of the shoulders
Delivery of the trunk

19. Prevention of perineallaceration
More attention should be paid not to the
perineum but to the controlled delivery of
the head.
Delivery by early extension is to be avoided.
Spontaneous forcible delivery of the head is
to be avoided.
To deliver the head in between contractions.
To perform timely episiotomy.
To take care during delivery of the shoulders
as the wider bisacromialdiameter emerges
out of the introitus

21. Median Medio-lateral
Merits -The muscles are not cut
-Blood loss is least
-Repair is easy
-Post operative comfort
is maximum
-Healing is superior
-Wound disruption is
rare
-Relative safety from
rectal involvement
from extension
Demerits -Extension , if occurs,
may involve the rectum
-Not suitable for
manipulative delivery or
in abnormal
presentation or position
-Apposition of the tissues
is not so good
-Blood loss is little more
-Post operative
discomfort is more
-Relative increased
incidence of wound
disruption
-Dyspareuniais
comparatively more

22. Baby should be placed on a tray covered with
clean dry linen with the head slightly
downwards soon after delivery.
Maintaining thermoregulation
Suctioning to clear the air passages
Maintaining cardio respiratory
function
Oxygen may be given as needed
until the infant cries vigorously
APGARscore

23. Category 0 1 2
Heart rate absent <100 >100
Respiratory
efforts
absent Slow irregularGood crying
Muscle tone flaccid some flexion of
extremities
Active motion
Reflex
irritability
No responsegrimace Vigorous cry
colour Blue,pale Body
pink,extremities
blue
Completely pink

24. Clamping and ligature of the cord
Documenting urination/passage of meconium
Administering vitamin K
Prophylactic eye care
Promoting parent-newborn bonding
Quick check is made to detect any gross
abnormality

25. Never leave the patient alone once she has been
transferred to the delivery room
Encourage the patient to rest between contractions
and to push with contractions
Position the patient’s legs in the stirrups for the
lithotomyposition
Prepare the patient’s perineum
Monitor the patient’s blood pressure and the fetal
heart beat every 5 minutes and after each contraction

26. Positions used
Standing supported squat

27. Semi-sitting

28. Sitting

29. Sitting on toilet

30. Squatting

31. Side-lying

32. Walking

33. Standing

34. Leaning or kneeling forward with support

35. Knee-chest

36. Lithotomy

37. Slow progress of labour
When the baby is in an unusual position
Concern about the baby’s condition
Perineal tear
Postpartum haemorrhage
Retained placenta
Umbilical Cord Prolapse
Umbilical Cord Compression