presentation on second stage of labor

In this slide you will get to know about what is second stage of labor and what are cardinal movements in mechanism of labor and its management are discussed in this slide

1. PRESENTATION ON SECOND STAGE OF LABOR Ms . Shailvi ( BSc.(H) Nursing student )

2. INTRODUCTION During the second stage of labor the whole tempo and nature of activities surrounding labor tend to change. Labor remain as a continuum ,at this time woman often become more vulnerable and dependent on the influence of those who assist them,

3. . Discussion about a lternative and choices is not easy at this time and this leaves the care giver with even more than usual responsibilities to safe guard the interest of the mother and baby.

4. definition The second stage of labor begins with complete dilatation of the cervix and ends with the birth of the baby . It is known as the stage of expulsion.

5. PHYSIOLOGICAL PROCESSES Descend Uterine action Rupture of membranes Soft tissue displacement

6. descend The average maximum rate of descend is 1.6cm/ hr in nulliparas and 5.4cm/ hr in multiparas.

7. Uterine action Contractions during the second stage are frequent ,strong & slightly longer that is approximately every 2 minutes lasting 60-90 seconds.

8. RUPTURE OF MEMBRANES The membranes often rupture spontaneously at the onset of second stage .

9. Soft tissue displacement As the hard fetal head descends ,the soft tissues of the pelvis become displaced . Anteriorly the bladder is pushed upwards into the abdomen where it is at less risk of injury during fetal descent .

10. Presumptive signs of second stage and differential diagnosis

11. Maternal physiological changes in 2 nd stage

12. Mechanism of normal labor When the fetus present in left or right occipitoanterior position the way the fetus is normally situated can be described as follows:-

13. Positional movements ENGAGEMENT :- Engagement takes place when the biparietal diameter of the fetal head has passed through the pelvic inlet.

14. descend Descend occur throughout the mechanism of labor and is therefore both the requisite to and simultaneously with the other mechanism.

15. FLEXION Flexion is essential to further descend. Pressure exerted down the fetal axis will be transmitted to the occiput. The effect is to increase flexion which result in the substitution of smaller suboccipitobregmatic diameter of 9.5cm for the larger suboccipitofrontal diameter of 10cm.

16. . .

17. Internal rotation of head In a well flexed vertex presentation the occiput leads and meets the pelvic floor first and rotates anteriorly through 1/8 th of circle. This causes a slight twist in the neck of the fetus as the head is no longer in direct allignment with the shoulders.

18. crowning At this stage, the maximum diameter of the head stretches the vulval outfit without any recession of the head even after the contraction is over. This is called crowning of head.

19. Birth of the head By further pressure from the contracting uterus and maternal pushing serves to further extend the head & the head is born by extension as the sinciput face & chin sequentially sweep over perineum.

20. restitution Restitution untwist the neck so that the head is again at right angle with the shoulders . The occiput moves1/8 th of circle towards the side from which it started .

21. Internal rotation of shoulder The anterior shoulder reaches the pelvic floor and rotates anteriorly1/8 th of a circle . The shoulder come to lie in the anteriorposterior diameter of the pelvic outlet.

22. External rotation of the head It occurs as the shoulders rotate 45 degree internally causing the head to rotate another 45 degree. External rotation occurs in the same direction as restitution and the occiput of the fetal head now lies laterally.

23. Birth of the shoulder and body by lateral flexion The anterior shoulder comes into view at the vaginal orifice where it impinges under the symphysis pubis while the posterior shoulder distends the perineum. After the shoulder are delivered the remainder of the body is born by lateral flexion.

24. MANAGEMENT OF SECOND STAGE OF LABOR PRINCIPLES To assist in natural expulsion of the fetus slowly and steadily. To prevent perineal injuries.

25. General measures The patient should be in bed. Constant supervision is mandatory and FHR is recorded at every 5 minutes. To administer inhalation analgesics if available in the form of gas N2O and O2 to relieve pain during contractions.

26. . Vaginal examination is done at the beginning of 2 nd stage not only to confirm its onset but to detect any accidental cord prolapse. The position and the station of the head are once more to be reviewed and the progressive descent of the head is ensured.

27. PREPARATION FOR DELIVERY Position. The accoucheur scrubs up. Toileting the external genitalia and inner side of thighs with betadine. Essential aseptic procedures are remembered as three Cs. Clean hands. Clean surface. Clean cutting and ligaturing of the cord. To catheterize the bladder if it is full.

28. CONDUCTION OF DELIVERY Delivery of the head. The patient is encouraged for the bearing down efforts during contractions . This fascilitates descent of the head.

29. . When the scalp is visible for about 5cm in diameter, flexion of head is maintained during contractions. This is achieved by pushing the occiput downward and backward by using thumb and index finger of left hand while processing the perineum by the right palm with a sterile vulval pad.

30. . If the patient passes stool it should be cleaned. When the perineum is fully stretched and threatens to tear especially in primigravidae episiotomy is done at this stage.

31. . Slow delivery of the head in between the contractions is to be regulated. The forehead , nose ,mouth and the chin are thus born successively over the stretched perineum by extension.

32. Care following the delivery of head Mucus and blood in mouth and pharynx to be wiped. Eyelids are wiped with sterile dry swabs. The neck is palpated to exclude the presence of any loop of cord.

33. PREVENTION OF PERINEAL LACERATION Delivery by early extension is to be avoided. Spontaneous forcible delivery of the head is to be avoided by assuring the patient not to bear down during contractions.

34. . To deliver the head in between contractions. To perform timely episiotomy. To take care during delivery of the shoulder as the wider bisacromial diameter emerges out of the introitus.

35. Delivery of shoulder The head is to be grasped both the hands and is gently drawn posteriorly until the anterior shoulder is released under the pubis. By drawing the head in upward direction the posterior shoulder is delivered out of perineum.

36. . Traction of the head should be gentle to avoid excessive stretching of neck causing injury to the brachial plexus , hematoma of the neck or fracture of clavicle.

37. DELIVERY OF THE TRUNK After the delivery of shoulder the forefinger of each hand are inserted under the axillae & the trunk is delivered gently by lateral flexion.

38. IMMEDIATE CARE OF THE NEW BORN Soon after the delivery of the baby it should be placed on a tray covered with clean dry linen. Air passage should be cleared by gentle suction APGAR rating at 1 min and 5 min.

39. . Clamping and ligature of the cord. The cord is divided with scissors about 1cm beyond the ligatures taking aseptic precautions Note presence of any abnormality The purpose of clamping the cord on maternal end is to prevent soiling of the bed and to prevent fetal blood loss.

40. . Delay in clamping for 2-3 min or till cessation of the cord pulsation fascilitates transfer of 80 -100 ml of blood. This is beneficial to mature baby but maybe deleterious to a preterm or low birth weight due to hypervolemia and hyperbilirubinemia.

41. Early clamping is done in cases of Rh incompatibility. Cord is usually clamped after cleaning the airway after about 1-2 mints of birth early clamping reduces the need of phototherapy due to hyperbilirubinemia. Quick check is made to detect any gross abnormality .

42. SUMMARY

43. conclusion 1)Over the course of second stage of labor upright and lateral positions may have more potential benefits improving maternal and neonatal outcomes and dealing with certain obstetric complications .

44. . 2) However when woman gives birth in upright position especially in squatting and sitting position midwives should pay close attention to the perineum to prevent perineal trauma. 3) Midwives play a roll in child birth so she should master the skills and techniques.

45. BIBLIOGRAPHY Dutta DC. Textbook of obstetrics. 9th edition. New delhi:jaypee brothers publication; 2018.page no. 128-130. Jacob anamma. Textbook of obstetrics and midwifery. 3rd edition;new delhi: jaypee brothers publication 2012. Page no. 166- 182.

46. EVALUATION

47. Thank you