nursing management of second stage of labour
TRANSCRIPT
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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