Management of second stage of labour
Principles;
1. To assess in natural expulsion of fetus slowly and steadily
2. To prevent perineal injury
Transition from first stage of labor to second stage of labor
1. Increase intensity of uterine contraction
2. Appearance of bearing down efforts
3. Urge to defecate with descent part presenting part
4. Complete dilatation of cervix, evidence by PV
General measures
1. Patient should be in bed
2. FHR recorded every five minutes
3. If required O2 support
4. Vaginal experiment
Detect any accidental cord prolapse
Position and station of head
Progressive descent of head
Preparation for delivery
1. Position
Lateral or partial sitting position
2. Bladder and bowel
Catherized bladder, if full.
Toileting external genitalia
3. Assess the contraction and pain
Conduction of delivery
1. Delivery of head
2. Delivery of shoulder
3. Delivery of trunk
1. Delivery of head
Crowning of head
Increase flexion of head.
Su- occipito frontal diameter (10cm)
Extension of head, distending valval outlet.
Delivery of head between contraction.
Head grapse by both hands.
2. Delivery of shoulder
Delivery of Anterior shoulder
Delivery of Posterior shoulder
Avoid stretching of neck
3. Delivery of trunk
After delivers shoulder, by lateral flexion delivery of trunk.
Prevention of perineal laceration
Support perineum
Perform timely episiotomy, If required.
Immediate care of new born
1. Soon after delivery of baby
Placed on tray covered with dry linen.
Head slightly downward (15degree)
Facilitated drainage of mucus accumulatd in tracheo-bronchial tree by gravity.
Baby placed between legs of mother and at lower level the uterus to facilitates gravitation of blood from placenta to infant.
2. Suctioning
Cleared mucus and liquor
3. APGAR rating
Within one minutes and 5 minutes recorded.
4. Clamping and ligature of the cord.
Cord clamp with two kocher's forceps to prevent fetal blood loss.
Delay clamping code for 2-3 minutes (80-100ml) blood from compressed placenta to baby when placed between the level of uterus.
Compress placenta to baby when placed below the level of uterus.
Beneficial to baby but not to prebirth baby due to hypervolaemia.
Early clamping done in case of Rh negative compatibility.
Detect any abnormality.
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