Management of second stage of labour

2nd stage labour and its management

1. Management of second stage of labour

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

3. Principles To assist in the natural expulsion of the fetus slowly and steadily To prevent perineal injuries

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

5. 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.

6. Maintain aseptic techniques

7. POSITIONING FOR DELIVERY

8. PERINEAL CLEANSING Need 6 swab balls Clean sequentially as shown by the numbers Clean according to the direction shown by the Arrows

9. CREATE A STERILE FIELD AROUND THE VAGINAL OPENING

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

11. Prevention of perineal laceration 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 bisacromial diameter emerges out of the introitus

12. episiotomy

13. Median Mediolateral 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 Dyspareunia is comparatively more

14. CROWNING OF THE HEAD

15. As the fetal head and advance and control it by supporting with one hand or both

16. Encourage mother to control by gently blowing or sighing and minimize each breath in order to minimize active pushing.

17. During the delivery of head the mid wife should support the anococcygeal region of the mother with a sterile towel in her right hand and while the left hand exerts pressure on the occiput.

18. DELIVERY OF THE HEAD 1. Ask the woman to pant or give only small pushes with contractions as the baby’s head delivers 2. To control birth of the head, place the fingers of one hand against the baby’s head to keep it flexed (bent) 3. Continue to gently support the perineum as the baby’s head delivers

19. 2nd stage of labour Head is borned by extension

20. Suction the baby’s nose n mouth

21. Ensure that the cord is not around the fetal head.

22. CORD AROUND THE NECK Feel around the baby’s neck for the umbilical cord If the cord is around the neck, attempt to slip it over the baby’s head If the cord is tight around the neck, doubly clamp and cut it before unwinding it from around the neck

23. The eye lids of are then wiped with sterile dry cotton swabs to minimize the contamination of conjunctival sac.

24. Delivery of anterior shoulder Anterior shoulder wedged behind the pubic symphysis

25. Direction of traction - should be in the direction of the axis of the body

26. DELIVERY OF POSTERIOR SHOULDER Lift the baby’s head anteriorly to deliver the shoulder that is posterior Support the rest of the baby’s body with one hand as it slides out Place the baby on the mother’s abdomen

27. DELIVERY OF POSTERIOR SHOULDER

28. Delivery of the trunk After the delivery of the shoulders, the fore finger of each hand is inserted under the axillae and the trunk is delivered gently by lateral flexion.

29. BABY DELIVERED

30. FIRST BODY CONTACT OF MOTHER AND BABY AND CORD CLAMPING

31. The cord is clamped and cut about 5 cm from the umbilicus

32. CLAMPING, CUTTING AND TYING OF UMBILICAL CORD

33. Immediate care of newborn 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 passage Maintaining cardio respiratory function Oxygen may be given as needed until the infant cries vigorously APGAR score

34. Category 1 2 Heart rate absent <100 >100 Respi r ato r y efforts absent Slow irregular Good crying Muscle tone flaccid some flexion of extremities Active motion Reflex irritability No response grimace Vigorous cry colour Blue,pale Body pink,ext r e m i t ies blue Completely pink

35. 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