Clinical features of 2nd stage of labour
Start with full dilatation of cervix and ends with expulsion of fetus from birth canal.
2nd stage of labor has two phase;
1. Propulsive phase
It starts from full dilatation of cervix upto descent of presenting part of the pelvic floor.
2. Expulsive phase
Maternal bearing down efforts and ends with delivery of baby.
1. Pain
Increase intensity of pain
In every 2-3 minutes, 60-90 seconds.
2. Show
Increase bloody show
3. Bearing down efforts
Expulsive phase (voluntary efforts)
May slowing FHR during pushing; normal once contraction over.
4. Membrane staus
Membrane may rupture, liquor.
5. Descent of fetus
Abdominal and vaginal examination;
Descent of head in relation to ischial spine.
Rotation of head by position of sagittal suture and occiput in relation to quadrants of pelvis.
Observe progressive descent of head.
Sinciput felt
Change in position of FHR shifted down word medially.
6. Bulging of perineum
Vulval opening become circular (expulsive phase)
7. Pressure on rectum
8. Crowning of head
Biparietal stretched vulval outlet.
9. Head delivered by extension, expel shoulder and trunk
10. Vaginal sign;
Gush of liquid (hind water; tinged with blood)
11. Station of head
-5; head floating over brim
0; ischial spine (deeply engaged)
+5;
Maternal sign
Features of exhaustion
Increase perspiration
During bearing down effort face congested with neck vein prominent.
Irritability
After expulsion of fetus, relief occur.
Fetal efforts
Slowing of FHR during contraction
Observe liquor (meconium stained or clean)
Observe fetal distress
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