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Chapter: Obstetric and Gynecological Nursing : Normal Pregnancy

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The Second Stage of Labour

It is the stage from full dilatation of the cervix (i.e no cervix felt on V.E) until the Baby is born:-

2. The Second Stage of Labour

 

Definition:

 

It is the stage from full dilatation of the cervix (i.e no cervix felt on V.E) until the Baby is born:-

 

Duration:

 

Primigravida 45 min – 1 hour, as long as 2 hrs

 

Multigravida 1/2 hour can be as little as 5 minutes.

 

N.B. there should always be advance or descent in this stage

 

Signs of Second Stage:

 

1.              No cervix felt on Vaginal examination

 

2.              Contractions are much stronger, and last 30-50 seconds

 

3.              The patient wants to push (Urge to push)

 

4.              Sometimes head can be seen at the vulva

 

Mechanism of the second stage:

 

Before we deliver a baby we must understand the mechanics or mechanisms of how the baby passes down through the pelvis. We also must know the pelvis, and certain definitions.

 

Mechanism: Is the series of movements of the fetus in itspassage through the birth canal.

 

Echanism of Labour in a Normal Vertex Presentation

 

Position- Left OcciputoTransverse

 

Lie -Longitudinal

 

Attitude- Flexion

 

Presentation-Vertex

 

Position- Left occiputo transverse

 

The head engages the pelvis with the Sagital suture in the transverse diameter of the pelvic brim

1.              Flexion and descent of the head: The head descends with increasing flexion; the occiput reaches the pelvic floor first.

 

2.              Internal Rotation of the head: (Whatever reaches the pelvic floor first must rotate forwards). As the occiput reaches the pelvix floor it rotates anteriorly.

 

3.              Crowing of the head: The occiput escapes under the symphysis put and the head no longer recedes between uterine contractions.

 

4.              Extension of the head: The face sweeps the perineum and the head is born by extension.

 

5.              Restitution of the head: This is the turning of the head to undo the twist in the neck that took place during internal rotation of the head.

 

6.              Internal rotation of the shoulders: Meanwhile the shoulders have entered the brim in the oblique diameter, and descend. The anterior shoulder reaches the pelvic floor and rotates forward, this cause.

 

7.              External rotation of the head:

 

8.              Lateral flexion of the body: The shoulders escape under the symphysis, and the rest of the body is born by lateral flexion.

 

NOTE: The mechanism in any other position follows the sameprinciples of

ENGAGEMENT – DESCENT – INTERNAL ROTATION, BIRTH AND EXTERNAL ROTATION.

 

MANAGEMENT OF THE SECOND STAGE

 

Once the patient is in the second stage the nurse must not LEAVE HER, and a constant and careful supervision must be kept on her:

 

1.              General condition, pulse, uterine contractions & Vulva

 

2.              Bladder should be empty

 

3.              Fetal heart more frequently (after every second contraction)

 

4.              Descent of the presenting part and programs is soon.

 

5.              Membrane should be ruptured

 

 

Preparation for Delivery:

 

A.  Equipment: have ready

 

Delivery: Set with 2 clamps, scissors, sterile towels, cord tigh, Bowl and kidney dish

ERGOMETRINE: 0.5mgs. in a syringe with swab ready to be given

SUCTION APARATUS, READY AND WORKING SAVLON 1 – 80 or any antiseptic lotion IDENTIFICTIONS: with name and number of mother EMPTY CONTAINER

 

 

B. Patient: - Position the mother, watch descent of head fetalheart and mothers condition.

·                 Encourage the mother & place her in position

 

·                 Explain to her what is happening

 

·                 Gloves on.

 

·                 Arrange and check equipment,

 

·                 Keep constant contact with mother

 

 

Conduct of Delivery

 

·                 SWAB VULVA: Drape delivery area with sterile towels. A sterile pad is used to cover the anus.

 

·                 If necessary do episiotomy on contraction

 

·                 When the Head Bulges: The perineum and the head is crowned, place one hand over it to control it and prevent it coming out quickly. The other hand is on a pad or gauze over the rectum to keep away stool and help control the head.

 

·                 When the head is born, keep one hand on it and wide the eyes with the other hand using dry cotton swab.

 

·                 Remove excess mucus from mouth, with gauze wrapped around finger look for cord a round the neck, if there and it is tight, clamp it twice & cut in between.

 

·                 Wait for rotation of the shoulders: Then with two hands graspe over the parietals, deliver them downwards, then upwards. And slide one hand under the body and lift it out

 

·                 Note Time of Birth and sex of baby, APGAR

 

·                 Lay baby down

 

·                 Clear Airways:  Make sure baby is breathing

 

o       Make sure baby is breathing put on identification. Then clamp cord about 10cm from the umbilicus in two places near each other and cut in between.

·                 Dry baby well and wrap in a fresh warm towel .then place him in a cot and continue with the third stage of labour.

 

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