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 primigravidae and
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.
8.
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14.
15. Principles
To assist in the natural expulsion of the fetus
slowly and steadily
To prevent perineal injuries
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 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
20.
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
- Dyspareunia is
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
APGAR score
23. Category 0 1 2
Heart rate absent <100 >100
Respiratory
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,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
lithotomy position
Prepare the patient’s perineum
Monitor the patient’s blood pressure and the fetal
heart beat every 5 minutes and after each contraction
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