NURSING MANAGEMENT OF 2ND STAGE OF LABOUR

DRISYA.V.R.1st Year PG Nursing

NORMAL LABOUR

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

SECOND STAGE OF LABOUR

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.

Its average duration is 2 hours in

primigravidae and 30 minutes in multiparae.

Second stage has two phases:

Propulsive

Expulsive

CLINICAL COURSE Pain Bearing down efforts Membrane status Descent of the fetus Vaginal signs Maternal signs Fetal effects

MECHANISM OF NORMAL LABOUR

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.

Principal movements are:

Engagement Descent Flexion Internal rotation Crowning Extension Restitution External rotation Expulsion of the trunk.

ENGAGEMENT AND DESCENT

FLEXION

INTERNAL ROTATION

EXTENSION

RESTITUTION

EXTERNAL ROTATIONEXPULSION OF THE TRUNK

MANAGEMENT

Principles

To assist in the natural expulsion of the

fetus slowly and steadily

To prevent perineal injuries

General measures

The patient should be in bed

Constant supervision

To administer analgesics

Vaginal examination

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.

Conduction of delivery

3 phases:

Delivery of the head

Delivery of the shoulders

Delivery of the trunk

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

EPISIOTOMY

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

IMMEDIATE CARE OF THE NEWBORN

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

APGAR SCORECategory 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

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

NURSING CARE OF PATIENT IN SECOND STAGE OF LABOUR

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

Positions used Standing supported squat

Semi-sitting

Sitting

Sitting on toilet

Squatting

Side-lying

Walking

Standing

Leaning or kneeling forward with support

Knee-chest 

Lithotomy

COMPLICATIONS DURING SECOND STAGE OF LABOUR

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

RESEARCHES

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