LABOUR 2nd stage
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The document summarizes the management of the second stage of labor. It describes: 1) Events that occur in the second stage, including full dilation of the cervix, rupture of membranes, and stronger uterine contractions that help push the baby down the birth canal. 2) General measures taken during the second stage like monitoring the patient and preparing for delivery by cleaning the perineal area. 3) The process of delivery, including maintaining flexion of the baby's head during crowning, performing an episiotomy if needed, and regulating the slow delivery of the head and shoulders before delivering the trunk. 4) Clamping and cutting the umbilical cord after full delivery.
LABOUR 2nd stage
- 2. Contd …IInd STAGE:- From full dilatation of cervix till fetus is delivered. Its 2 hrs in primigravidae and 30 min. in multiparae. Propulsive phase: full diltation upto descent of the presenting part Expulsive phase: maternal bearing down efforts to delivery of the baby
- 3. Events in the second stage of labour WITH FULL DILATATION OF THE CERVIX, MEMBRANES USUALLY RUPTURE ESCAPE OF GOOD AMOUNT OF LIQOUR AMNII THEREBY VOLUME OF UTERINE CAVITY REDUCES SIMULTANEOUSLY UTERINE CONTRACTIONS & UTERINE RETRACTIONS BECOME STRONGER UTERUS BECOME ELONGATED DURING CONTRACTIONS, WHILE THE ANTERO-POSTERIOR & TRANSVERSE DIAMETERS ARE REDUCED ELONGATION IS PARTLY DUE TO CONTRACTIONS OF THE CIRCULAR MUSCLE FIBRES OF THE UTERUS TO KEEP THE FETALAXIS STRAIGHT
- 4. 1 DELIEVERY OF THE FETUS IS ACCOMPLISHED BY THE DOWNWARD THRUST OFFERED BY UTERINE CONTRACTIONS SUPPLEMENTED BY VOLUNTARILY CONTACTION OF ABDOMINAL MUSCLES AGAINST THE RESISTANCE OFFERED BY BONY & SOFT TISSUES OF THE BIRTH CANAL THERE IS ALWAYS A TENDENCY TO PUSH THE FETUS BACK INTO THE UTERINE CAVITY BY ELASTIC RECOIL OF THE TISSUES OF THE VAGINA & PELVIC FLOOR, THIS IS COUNTERBALANCED BY THE POWER OF RETRACTION WITH INCREASING CONTRACTIONS & RETRACTIONS , UPPER SEGMENT BECOMES THICKER WITH CORRESPONDING THINNING OF LOWER SEGMENT AFTER THE EXPULSION OF THE FETUS, UTERINE CAVITY IS PERMANENTLY REDUCED IN SIZE TO ACCOMMODATE THE AFTER BIRTH
- 5. MANAGEMENT OF THE SECOND STAGE Transitional features:
- 7. Cont:
- 8. Vaginal examination is done at the beginning of second stage to: detect cord prolapse
- 9. Vaginal examination: -To assess descent of head -note the station and position of head ,
- 10. • Nothing is given by mouth except sips of water or ice
- 11. PREPARATION FOR DELIVERY: 1) Shifting to labor table when- Quick succession of bearing down efforts
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- 13. Delivery beds of DMCH
- 14. Toileting external genitalia The accoucheur (person going to deliver)scrub up and wear strile gown ,glove and mask and stand at right side of the table
- 15. 2)TOILETING THE EXTERNAL GENITALIA- One sterile sheet is placed beneath the buttocks of the patient and one over the abdomen and 2 on the legs. Perineal area is cleaned starting from Mons pubis toward labia majora, labia minora,clitoris to urethra toward rectum and then thigh . 3)REMEMBER 3 C’S: a)Clean hands b)clean surface c)clean cutting and ligating of cord. Cont:
- 16. NURSING CARE GIVEN WHILE IN THE DELIVERY ROOM
- 17. 3)POSITION OF THE PATIENT: Upright position should be given to a lady in second stage of labour. 4) SCRUBBING: Accoucheur (person going to deliver)scrubs up and puts on sterile gown, mask and gloves and stands on the right side of the table
- 18. 5)TOILETING THE EXTERNAL GENITALIA- and inner side of the thighs with cotton swabs soaked in betadine solution One sterile sheet is placed beneath the buttocks of the patient and one over the abdomen and 2 on the legs. Perineal area is cleaned starting from Mons pubis toward labia majora, labia minora,clitoris to urethra toward rectum and then thigh . Cont………….
- 19. Prepare the patient's perineum. A betadine scrub is used. Clean the perineum by washing the pubic area, down. NURSING CARE WHEN PREPARING PERINEUM
- 20. Discard used sponges after each step. Rinse area with the remaining solution. 5) TO CATHETERISE THE BLADDER, IF IT IS FULL Cont…….
- 23. Cont………….
- 24. Principle: To maintain flexion of the head so as to prevent early extension and to regulate its slow escape out of the vulval outlet. Delivery of head
- 25. Steps to follow: When perineum is fully stretched i.e.during crowning, episiotomy is done at this stage after prior infiltration with 10ml of 1% lignocaine Slow delivery of head in between contraction is regulated.
- 26. Prevention of perineal laceration
- 27. Cont……..
- 28. Cont……
- 29. Cont………….
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- 32. Whole body is delivered by lateral flexion Delivery of trunk
- 33. The cord is clamped by Kocher's forceps, the near one is placed 5cm away from the umblicus and other one is placed 2.5cm away from the naval. Then in-between the two kocker’s forceps cut is given with cord cutting scissor . Spillage of blood is prevented by placing gauze piece near cord cutting scissor. Clamping and ligature of cord
- 34. 1)----------- position is to be given during 2nd stage of labour. Ans…Upright position 2)Show means? Ans: mucus pug with blood. 3)Which anesthesia is used before giving episitomy? Ans:1%lignocaine Recaptulization
- 35. What is a pattern of breathing during contraction? Ans. Breathe in thro’ nose and out thro’mouth. What are the 3 c’s of delivery Ans. a)Clean hands b)clean surface c)clean cutting and ligating of cord. Cont:
- 36.