�ݺ�ߣ

INTRA PARTUM MONITORING
The nature of the transition and Second stage Phase of
labour
The second stage of labour has traditionally been regarded
as the phase between full dilatation of the cervical os and
the birth of the baby.
UTERINE ACTION
Contraction become stronger and longer allowing both
mother and fetus regular recovery periods. The
membrance often rupture spontenously towards the end of
the first stage. The conequent drainage of liqur allows the
hard round fetal head to be directly applied to the verginal
tissues.

This pressure aids distortions. Fetal arial pressure
increase thereon of the head, resulting in smaller
pressuring diameters more radial proress and less
trauma to both mother and fetus.
The contractions become expulsive as the
fetus descends further into the vagina. Pressure
from the presenting part stimulates nerve
receptor in the pelvic floor. This phenomenon Is
termed the Ferguson refute.

SELF TISSUE DISPLACEMENT
As the fetal head descends the soft tissues of
the pelvis become displaced. Anteriorly the
bladder is pushed upwards in to the abdomen
where it is at less risk of injury during fetal
descend. This result in the streching and thinning
of the urethra. So that its lumen is
reduced.Posteriorly the rectum be comes
flatterned into the everal corre and the presurre
of the advancing head expels any residual facial
matter. The levetur ani muscles dilate this out
and the perineal body is flatterned , treached and
thinned.

Tontraction and the fetal head becomes viible
at ultra advancing with each contraction and
recoding between contraction unit crowning
takes place. The follow with the next
contraction accompanied by a gush of
aminotic fluid and sometimes of blood. The
econd stage culmintaes in the birth of the
baby.

RECOGNITION OF THE
COMMENCEMENT OF THE SECONFD
STAGE OF LABOUR
Progress from the first to the second stage is not
always clinically apparent.

PRESUMPTIVE EVIDENCE
Expulsive Uterine Contraction:
Some woman feel a strong desire to puh
before full dialataion ocass. Traditionally it has
been assumed that an early stage to push will
lead to materal exhauion , carvial edema, or
trauma.
Rupture Of the Forewaters
Rupture of the forewaters may acces at any
time during labour.

Dialatation and Gapping of the anes:
Deep engagement of the presenting part may
produce this during during the latest phase of
the first stage.
Analcleftline
Some midwives here reported observing this
line a a pigment make in the cleff of the
button which crops upto the anal cleft as the
labour progress also called as people line.

Appearances of the rhomboid of michaclis
This is sometime noted when a women is in
position where her back is visible .It present as a
dove shaped crove in the lower back and is held
to indicate the posterior displacement rof the
moras into the maternal acrial curvr. This seems
to labouring women to arch her back puh he
buttocks forward and throw her armes back to
grasp and fired object she can find.

Upper Abdominal Pressure and Epidrial Analysia
It has been observed anecdotally that women who
have an epideral instit often have a sense of
discomfort under the ribs toward the end of the first
stage of labor.
SHOW
This I the los of blood srtain nussess which often
accompanies rapid dilation of the cervical as towards
the end of the first stage of labor.

Appearances Of The Presenting Part
Excessive molding may result in the
formation of a large caput succedaneum
which can protrude through the cervix prior to
full dilation of the o very occasionally a baby
presenting by the vertex may be visible at the
perineum at the same time a remaining
cervix. This Is more common in women of high
priority.

Confirmatory Evidence:
In many midwifery settings it Is held that
regional examination must be undertaken to
confirm full dilation of the cervical os. This Is
both to ensure a women is not puhing too
early and to provide a base line. For timing the
length of the second stage of labor

PHASE AND DURATIONS
The Latent Phase
In some woman full dilation of cervical as is
recorded but the presenting part may not yet
have reached the pelvic outlet. She may not
experience a strong expulsive urge until the
head has descended sufficiently to even
pressure on the return and perinea tissues.

Active Phase
Once the fetal head Is visible the women will
usually experience a compulsive urge to puh.
Duration of the Second Stage
There is no good evidence about the absolute
time limit of physiological labor. It average
2hrs in primigavide and 30 mits in
multiphase.

The Mechanisam of Normal Labor
As the fetus descends soft tissues and body
structures exact preserves which lead to
decent through the birth canal by a cervices
movements. Collectively three movements
one called the mechanism of labour

PRINCIPLE COMMON TO ALL
MECHANISMS ARE
 Decent takes place.
 Whatever part leads and first meets the resistance of the pelvic flar
will rotate towards until it comes under the symphyics parts
 Whatever emerges from the pelvic will pivot around the pubic
bone.
 The live is longitudinal
 The presentation is cephalic
 The position to right or left ocipi to anterior
 The attitude I one of the good florion
 The Denomination is the aciput
 The presenting part is the posterior part of the anterior partal
bone.

MAIN MOVEMENT OF THE FETUS
Descent
Decent of the fetal head into the pelvic often begins
before the arrest of the labor. For a primigravid woman
this usually occurs during the later weeks of
preganancy. In multigravid woman muscle tone is often
more lax and therefore descent and engagement of the
fetal head may not occur until labor actually begins .
Through out the first stage of labor the contraction and
retraction of the where muscles allow lers room in the
utrus exerting pressure on the fetus to descend
further. Following rupture of the jore water and the
exertion of material effort, progress speeds up.

FLXION
This increase throughout the labor . The fetal
spine is attached nearest the posterior part of the
skull, pressure exerted down the fetal arias will
be more forcibly transmize to the output than the
siniput. The effect Is to increase theron when
results in smaller presnting diameter which will
negotiate the pelvi more easily. At the outset of
labour the suboccipilo fontal diamate , which Is
on average approximately 10 cm is presenting
with greater function the ubocipho pregmativ
diameter on average approximately 9. cm
pesents. The output becomes the leading part.

Internal Rotation Of the Head
Duing a contruction the leading part is pushed
onwards onto the pelvic floor. The resistance of
thi muscular diaphrighn bring about rotation . As
the construction fades the pelvic floor rebounds
caring the output to glid towards resistance Is
therefore as important determinant of rotation .
This explains why the rotations is often delayed
following epidunal analyia which cover relatiob of
pelvic floor muscle. The selope of the pelvic floor
determines the dimention of rotation

The muscles are hammer shaped and slope down anteriorly
, so whichever part of the fetu first meets the laternal half
of this slope will be directed forwards and towards the
center. In a well flex restore presentation the output lead
and rotate extremely through 1/8 of a circle when it meets
the pelvic floor. This causes a slight twist in the neck as
head is no longer in direct alignment with the shoulders.
The anteroposterior diameter of the head now lies in the
wildest diameter on the pelvic outlet. The ouput lips
beneath the sub public arch and crowling awr when the
head no longer recedes between contraction and the
widest maniverse diameter is born. If fetu I maintained the
subacipitobromatic diameter uually approximately 9.cm
distrens the vaginal arifire.

EXTENSION OF THE HEAD
Once crowning has occurred the fetal head
can extend piroting on the subaciptal region
around the pelvic bone.
This releases the sinipet face and chin which
sweep the perinium and then are born by a
movement of extenion

RESTITUTION
The twist in the neck of the fetus which resulted
from internal rotation Is not connected by a slight
untwisting movemet. The output mores I of a
circle toward the side from which I shatered

INTERNAL ROTATION OF THE
SHOULDERS
The shoulders undergo a similar rotation to
that of the head to lie in the widest diameter
of the pelvic outlet namely enteroposteries.
The anterior shoulder is the first to reach the
elevator ani muscle and it therfore rotates
anteriorly to live under the symphysis pubies.
Thus movement can be clearly seen as the
head turns at the same time. It occurs in the
same direction as restitution and the accept of
the fetal head now lies laterally.

LATERAL FLEXION
The shoulder are usually born sequentially . When the
mother Is in a supported sitting positions, the anterior
shoulder is usually born first. Although it has been
noted by midwives who commonly use upright or
kneeling positions that the posterior shoulder is
commonly seen first. In the former care the anterior
shoulder lips beneath the sub public arch and the
posterior shoulder posses over the perinum. This
enables a smaller diameter to distend the vaginal
orifice. Then if both shoulder were born
simultaneously. The remainder of the body Is born by
lateral flexion a the spine bends sideways through the
curved birtgcanel

�ݺ�ߣ

SECOND STAGE-OF LABOUR.pptx

Recommended

More Related Content

Similar to SECOND STAGE-OF LABOUR.pptx (20)

Recently uploaded (20)

SECOND STAGE-OF LABOUR.pptx