normal labour,second stage by dr yin moe
TRANSCRIPT
Dr. Yin Moe HanSenior Lecturer
Obstetrics & Gynaecology Department School of Medicine, UCSI university
04/13/2304/13/23
SECOND STAGE OF LABOUR
full dilatation of the cervix full dilatation of the cervix
up to up to 1 hour1 hour
birth of the foetusbirth of the foetus
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MECHANISM OF NORMAL LABOUR
Cardinal movements of labour (LOA)
Head is borned by Extension
Restitution
External rotation
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Head is borned by EXTENSION
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RESTITUTION
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EXTERNAL ROTATION
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NORMAL CHILDBIRTH
General methods of General methods of supportive care during supportive care during labour are most useful labour are most useful in helping the woman in helping the woman tolerate labour pains tolerate labour pains
Once the Once the cervix is fully cervix is fully dilated dilated and the woman is and the woman is in the expulsive phase in the expulsive phase of the second stageof the second stage, , encourage the woman to encourage the woman to assume the assume the positionposition she she prefers and encourage her prefers and encourage her to push to push
Positions that a woman may Positions that a woman may adopt during childbirthadopt during childbirth
There must be enough room in front of mom to care for the infant
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POSITIONING FOR DELIVERY
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PERINEAL CLEANSING
Need 6 swab balls
Clean sequentially asshown by the numbers
Clean according to the direction shown by the Arrows
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CREATE A STERILE FIELDAROUND THE VAGINAL OPENING
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CROWNING OF THE HEAD
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EPISIOTOMY NoteNote::
Not a routine Not a routine procedureprocedure
Do not decreaseDo not decrease perineal damageperineal damage future vaginal future vaginal
prolapseprolapse urinary incontinenceurinary incontinence
Associated withAssociated with an increase of 3an increase of 3rdrd & &
44thth degree tears degree tears subsequent anal subsequent anal
sphincter muscle sphincter muscle dysfunction. dysfunction.
Considered only in:Considered only in:
complicated vaginal complicated vaginal deliverydelivery
breechbreech shoulder dystociashoulder dystocia forcepsforceps vacuumvacuum
scarring from female scarring from female genital mutilation or genital mutilation or poorly healed third poorly healed third or fourth degree or fourth degree tears tears
fetal distress.fetal distress.
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ASSISTING WITH DELIVERY
As crowning occurs, As crowning occurs, place a hand on the top place a hand on the top of the baby’s head and of the baby’s head and apply light pressureapply light pressure
Instruct the mother to Instruct the mother to focus on her breathing. focus on her breathing. Have her “pant like a Have her “pant like a dog” to help her stop dog” to help her stop pushing and prevent a pushing and prevent a forceful birth.forceful birth.
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DELIVERY OF THE HEAD
Ask the woman to pant or Ask the woman to pant or give only small pushes give only small pushes with contractions as the with contractions as the baby’s head delivers baby’s head delivers
To control birth of the To control birth of the headhead, place the fingers of , place the fingers of one hand against the one hand against the baby’s head baby’s head to keep it to keep it flexed (bent) flexed (bent)
Continue to Continue to gently support gently support the perineum as the baby’s the perineum as the baby’s headhead delivers delivers
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DELIVERY OF THE HEAD
Head is borned by extension
2nd stage of labour
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SUCTION THE BABY’S MOUTH AND NOSE
Once the baby’s Once the baby’s head delivers, ask head delivers, ask the woman not to the woman not to pushpush
Suction the baby’s Suction the baby’s mouth and nosemouth and nose
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SUCTION THE AIRWAY
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If the cord is around the neck, attempt to slip it over the baby’s
head
CORD AROUND THE NECK
Feel around thebaby’s neck
for the umbilical cord
If the cord is tight around the neck, doubly clamp and
cut it before unwinding it from around the neck
If the cord is tight around the neck, doubly clamp and
cut it before unwinding it from around the neck
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ASSISTING WITH DELIVERY
Use a clean towel to catch the baby
Note the time, if possible
Check to see if the umbilical cord is looped around the baby’s neck. If so, gently slip it over the head
As the head emerges, the baby will turn to one side (for easier passage of shoulders through birth canal)
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DELIVERY OF FETAL HEAD WITH ROL POSITION
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DELIVERY OF ANTERIOR SHOULDER
Anterior shoulder wedged
behind the pubic symphysis
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DELIVERY OF ANTERIOR SHOULDER
Direction of traction- should be in the direction of the axis of the body
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COMPLETION OF DELIVERY
Allow the baby’s head Allow the baby’s head to turn spontaneously. to turn spontaneously.
After the head turns, After the head turns, place a hand on each place a hand on each side of the baby’s side of the baby’s head. Tell the woman head. Tell the woman to push gently with to push gently with the next contraction. the next contraction.
Reduce tears by delivering
one shoulder at a time
Move the baby’s head Move the baby’s head posteriorly to deliver posteriorly to deliver the shoulder that is the shoulder that is anterior anterior
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DELIVERY OF POSTERIOR SHOULDER
Lift the baby’s head anteriorly to deliver the shoulder that is posterior
Support the rest of the baby’s body with one hand as it slides out
Place the baby on the mother’s abdomen
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DELIVERY OF POSTERIOR SHOULDER
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BABY DELIVERED
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FIRST BODY CONTACT OF MOTHER AND BABY AND CORD CLAMPING
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CLAMPING UMBILICAL CLAMPING UMBILICAL CORDCORD
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CLAMPING, CUTTING AND TYING
OFUMBILICAL CORD
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