The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
This presentation includes all the events , its sign and symptoms about IOL as well as management of women in the first stage of labor and how to assess the women in labor with the help of partograph.
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
It explains the mechanism of normal labour to medical and para-medical staff.It also puts light on principle movements underlying mechanism of normal labour with pictures.Thank You Like an share it to the maximum.
This presentation includes all the events , its sign and symptoms about IOL as well as management of women in the first stage of labor and how to assess the women in labor with the help of partograph.
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
physiology of labor includes the contraction and retraction of the muscles of uterus. I hope this presentation will help the persons of concerned subject.
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3. Introduction
Labor : Uterine contractions resulting in progressive
dilation and effacement of the cervix and
accompanied by descent and expulsion of the fetus.
Abnormal labor, dystocia, and failure to progress are
terms used to describe a difficult labor pattern
Approximately 20 % of labors involve dystocia
4. Stages of labor
NORMAL LABOR — divided into Four stages
First stage: time from the onset of labor until
complete cervical dilatation
Second stage: time from complete cervical dilatation
to expulsion of the fetus
Third stage: time from expulsion of the fetus to
expulsion of the placenta
Fourth stage: the 1st
post partum hour..
5. Recommendations on definitions of
the first stage of labor:
The first stage is further subdivided into the latent
active ,and transition phase
latent phase-
onset of regularly perceieved contractions and ends
when rapid cervical dilatation begins
Contractions are mild
Lasting 20-40 seconds
Cervical effacement occurs,cervix dilate 0-3 cm
6 hours in nullipara and 4.5 hours in multipara.
6. .ACTIVE PHASE
Cervical dilatation increasing from 4-7 cm
Contractions last 40-60 seconds and occur every 3-5
minutes
3 hours in nullipara and 2 hours in multipara
Show and spontaneous ruptures of membranes may
occur
7. ACTIVE PHASE DIVIDED INTO
THREE ADDITIONAL PHASES:
-Acceleration phase
-phase of maximum slope
-deceleration phase
8. TRANSITION PHASE
CONTRACTIONS REACH THEIR PEAK OF
INTENSITY
CERVICAL DILATATION INCREASE FROM 8- 10CM
CONTRACTIONS LASTS FOR 60- 90 SECONDS
OCCUR EVERY 2-3 MINUTES
IF THE MEMBRANES ARE NOT RUPTURED
PREVIOUSLY THEY WILL RUPTURE AT 10 CM
19. Diagnosis of labor
The determination of whether a woman is in labor is made
within one hour of admission .
Diagnosis of labor is made only when painfull contractions
are accompanied by any one of the following :
Bloody show
Rupture of the membranes
Full cervical effacement.
Cervical dilatation is not part of the criteria
Meet the criteria
Didn’t meet the
criteria
Rest &
observation
Until next day
Antinatal
ward
20. Diagnosis of labor
The correct diagnosis of labor is considered to be the
single most important determination in the
management of labor because an incorrect diagnosis
of active labor will lead to inappropriate
interventions and an increased likelihood of cesarean
delivery.
21. MANAGEMENT OF FIRST STAGE
OF LABOUR
OBJECTIVE-TO HAVE A WATCHFUL EXPECTANCY
AND TO MONITOR THE PROGRESS OF LABOUR
AND TO PREVENT COMPLICATIONS
INITIAL ASSESSMENT-
Onset of contraction
Frequency
Duration
Memebrane
Liquor
Present and previous obstetric history,drug history
32. MANAGEMENT
GENERAL-emotional support and assurance are
given
BOWEL-encourage women for warm bath,soap
enema
REST AND AMBULATION-when membranes are
intact women is encouraged for ambulation,when
ruptured women advised for rest.
DIET-fruit juice ,soup,salt lemon juice is
recommended.NPO 6-8 hours prior to surgery
BLADDER CARE-encourage the women to empty the
bladder,if failed catheterization with aseptic tecniques
36. Cont…..
Watch for maternal and fetal well being.
Psychological preparation of the mother
P/V examination should be done :
1 to 4 hours in the first stage and at 1 hour intervel at
the second stage
At rupture of membranes to evaluate for cord
prolapse
Prior to intrapartum administration of analgesia
When the parturient feels the urge to push
When the FHR falls,to evaluate the conditions like
uterine rupture or cord prolapse
37. Contd….
Placement of intravenous line at the time of admission is
recommended.-it is found that women who received
Intravenous hydration at 250ml/hr had fewer labors
persisting for over 12 hours and less need for oxytocin
augmentation than those who received 120ml/hr.
ANTIBIOTIC PROPHYLAXIS –in some centers to prevent
early onset neonatal infection intravenous penicillin is given
38. Active management of labor
It refers to active control, rather than passive observation,
over the course of labor by the obstetrical provider.
It includes three essential elements
I. Careful diagnosis of labor by strict criteria
II.Constant monitoring of labor with specific standards for
normal progression
III.Prompt intervention (eg, amniotomy, high dose
oxytocin) according to established guidelines if progress
is unsatisfactory .
39. Active management of labor
The active management of labor is generally limited to
women who meet the following criteria:
1) Nulliparous
2)Term pregnancy
3)Singleton infant in cephalic presentation
4)No pregnancy complications
5)Experiencing spontaneous onset of labor.
40. Active management of labor
Nulliparous labor tends to be more subject to failure
to progress .
administration of oxytocin, sometimes at high
dosages, is one of the interventions involved in active
management. This is safer in nulligravid women since
the nulligravid uterus is virtually immune to rupture
(except as a result of manipulation or previous
surgery)
41. Active management of labor
Recommendation on routine amniotomy
Limited evidence showed no substantial benefit for
early amniotomy and routine use of oxytocin
compared with conservative management of labor.
In normally progressing labor, amniotomy should not
be performed routinely.
Combined early amniotomy with use of oxytocin
should not be used routinely.
42. ACTIVE MANAGEMENT OF
LABOUR
Interventions with amniotomy,and/or high dose
oxytocin are initiated if progress does not succeed
according to the defined standards.
Rupture of the fetal membranes provides
information
About fetal status,but does not appear to significantly
accelerate labour.In the dublin protocol,rupture must
be performed before treatment with oxytocin which is
administered only in the presence of clear amniotic
fluid.
43. ACTIVE MANAGEMENT OF
LABOUR
If membranes are ruptured when there is
polyhydramnios or an inengaged fetal presenting
part,it is prudent to use a small gauze needle,rather
than a hook,to puncture the fetal membranes in one
or more places,and to perform the procedure in the
operating room.This controlled amniotomy permits
emergency cesarean delivery in the event of an
umbilical cord prolapse.
Routine amniotomy should not be performed in
women with active hepatitis B and C or HIV inoreder
to minimize exposure of the fetus to ascending
infection.
44. ACTIVE MANAGEMENT OF
LABOUR
Slower progress in the nulliparous patient is most
often the result of inefficient uterine action.
In the absence of medical contraindications,labour
that falls to progress is treated with oxytocin.
45. MONITORING
It is desirable that all examinations should be done by
single individual to minimize interobservor
variations.
A vaginal examination during labour often raises
anxiety and interrupts the women focus
Increased number of vaginal examination is
associated with neonatal sepsis
46. Monitoring:
Recommendations on monitoring during the
established first stage of labor
A pictorial record of labor (partogram) should be used once labor is established.
4 hourly temperature and blood pressure
hourly pulse
half-hourly documentation of frequency of contractions
frequency of emptying the bladder
vaginal examination offered 4 hourly, or when there is concern about progress
Intermittent auscultation of the fetal heart after a contraction should occur for at least
1 minute, at least every 15 minutes, and the rate should be recorded as an average.
48. DIAGNOSIS OF POOR
PROGNOSIS OF LABOUR
Prolonged bradycardia and meconium stained liquor
Possibility of foetal distress
Prolonged latent phase when more than eight hours
in primigrvida and more than six hours in
multigravida
Prolonged latent phase may be due to fault in power,
passage or passenger
Passage is small due to contracted pelvis
Passenger, hydrocephalous, brow [occiput not felt]
Large baby, shoulder presentation
49. ROLE OF NURSE IN CARING OF THE WOMAN IN
THE FIRST STAGE OF LABOUR
Admitting client to birthing area after determining
that client is in labor
Determining if client's membranes have ruptured
Encouraging family participation as appropriate with
the labor process
Performing Leopold maneuver and vaginal exams as
appropriate
Monitoring maternal vital signs and fetal heart rate
and patterns, reporting any deviations or
abnormalities
50. CONTD…..
Applying electronic fetal monitor as appropriate
Assessing pain level, instituting positioning,
breathing, relaxation, and other methods for pain
control; administering analgesics as ordered
Providing ice chips, wet washcloth, or hard candy
Encouraging voiding at least every 2 hours
Assisting with anesthetic administration
Assisting with amniotomy with assessment of fetal
heart rate, fetal positioning, and fetal cord after
amniotomy
51. CONTD….
Assisting with amniotomy with assessment of fetal
heart rate, fetal positioning, and fetal cord after
amniotomy
Cleansing perineum and assisting with pad changes
regularly
Monitoring progress including vaginal discharge,
cervical dilation and effacement, position, and fetal
descent
Performing vaginal examinations as necessary
Assisting coach and supporting client and partner
52. CONTD…..
Palpating to determine contraction intensity
Reassuring client about normal fetal heart rates
Adjusting monitor to achieve and maintain clear
tracing
Interpreting rhythm strips when at least a 10-minute
tracing has been obtained
53. CONTD…..
Preparing supplies and equipment for delivery
Notifying primary health care provider at appropriate
time to scrub for attending delivery
Verifying maternal and fetal heart rate response to
uterine contractions during intrapartal care
Instructing client and partner about reasons for
electronic monitoring
Applying tocotransducer snugly after determining
fetal position via Leopold maneuver