The document summarizes the management of the second stage of labor. It describes: 1) Events that occur in the second stage, including full dilation of the cervix, rupture of membranes, and stronger uterine contractions that help push the baby down the birth canal. 2) General measures taken during the second stage like monitoring the patient and preparing for delivery by cleaning the perineal area. 3) The process of delivery, including maintaining flexion of the baby's head during crowning, performing an episiotomy if needed, and regulating the slow delivery of the head and shoulders before delivering the trunk. 4) Clamping and cutting the umbilical cord after full delivery.

2. 
Contd
…IInd STAGE:-
From full dilatation of cervix
till fetus is delivered. Its 2 hrs
in primigravidae and 30
min. in multiparae.
Propulsive phase: full
diltation upto descent of the
presenting part
Expulsive phase: maternal
bearing down efforts to
delivery of the baby

3. 
Events in the second stage of
labour
WITH FULL DILATATION OF THE CERVIX,
MEMBRANES USUALLY RUPTURE
ESCAPE OF GOOD AMOUNT OF LIQOUR AMNII
THEREBY VOLUME OF UTERINE CAVITY REDUCES
SIMULTANEOUSLY UTERINE CONTRACTIONS &
UTERINE RETRACTIONS BECOME STRONGER
UTERUS BECOME ELONGATED DURING
CONTRACTIONS, WHILE THE ANTERO-POSTERIOR
& TRANSVERSE DIAMETERS ARE REDUCED
ELONGATION IS PARTLY DUE TO CONTRACTIONS
OF THE CIRCULAR MUSCLE FIBRES OF THE
UTERUS TO KEEP THE FETALAXIS STRAIGHT

4. 
1
DELIEVERY OF THE FETUS IS ACCOMPLISHED BY
THE DOWNWARD THRUST OFFERED BY UTERINE
CONTRACTIONS SUPPLEMENTED BY
VOLUNTARILY CONTACTION OF ABDOMINAL
MUSCLES AGAINST THE RESISTANCE OFFERED
BY BONY & SOFT TISSUES OF THE BIRTH CANAL
THERE IS ALWAYS A TENDENCY TO PUSH THE
FETUS BACK INTO THE UTERINE CAVITY BY
ELASTIC RECOIL OF THE TISSUES OF THE
VAGINA & PELVIC FLOOR, THIS IS
COUNTERBALANCED BY THE POWER OF
RETRACTION
WITH INCREASING CONTRACTIONS &
RETRACTIONS , UPPER SEGMENT BECOMES
THICKER WITH CORRESPONDING THINNING OF
LOWER SEGMENT
AFTER THE EXPULSION OF THE FETUS,
UTERINE CAVITY IS PERMANENTLY REDUCED
IN SIZE TO ACCOMMODATE THE AFTER BIRTH

5. 
MANAGEMENT OF THE SECOND STAGE
Transitional features:

6. 
GENERAL MEASURES

7. 
Cont:

8. 
Vaginal examination is
done at the beginning
of second stage to:
 detect cord prolapse

9. 
Vaginal examination:
-To assess descent of head
-note the station and position of head
,

10. 
• Nothing is given by mouth except sips of
water or ice

11. 
PREPARATION FOR DELIVERY:
1) Shifting to labor table when-
 Quick succession of bearing
down efforts

12. 

13. 
Delivery beds of DMCH

14. 
Toileting external genitalia
The accoucheur (person going
to deliver)scrub up and wear
strile gown ,glove and mask
and stand at right side of the
table

15. 2)TOILETING THE EXTERNAL GENITALIA-
One sterile sheet is placed beneath the buttocks of the
patient and one over the abdomen and 2 on the legs.
 Perineal area is cleaned starting from Mons pubis
toward labia majora, labia minora,clitoris to urethra
toward rectum and then thigh .
3)REMEMBER 3 C’S:
a)Clean hands b)clean surface c)clean cutting and ligating
of cord.
Cont:

16. 
NURSING CARE GIVEN WHILE IN THE DELIVERY
ROOM

17. 
3)POSITION OF THE
PATIENT:
Upright position should
be given to a lady in
second stage of labour.
4) SCRUBBING:
Accoucheur (person
going to deliver)scrubs up
and puts on sterile gown,
mask and gloves and
stands on the right side of
the table

18. 
5)TOILETING THE EXTERNAL
GENITALIA- and inner side of the
thighs with cotton swabs soaked in
betadine solution
 One sterile sheet is placed
beneath the buttocks of the patient
and one over the abdomen and 2
on the legs.
 Perineal area is cleaned starting
from Mons pubis toward labia
majora, labia minora,clitoris to
urethra toward rectum and then
thigh .
Cont………….

19. 
 Prepare the patient's perineum.
 A betadine scrub is used.
 Clean the perineum by washing the pubic area,
down.
NURSING CARE WHEN PREPARING PERINEUM

20. 
 Discard used sponges after each step.
 Rinse area with the remaining solution.
5) TO CATHETERISE THE BLADDER, IF IT IS FULL
Cont…….

21. 
CONDUCTION OF DELIVERY
DELIVERY
OF
HEAD
DELIVERY
OF
SHOULDERS
DELIVERY
OF
TRUNK

23. 
Cont………….

24.  Principle:
To maintain flexion of the head so as to prevent early
extension and to regulate its slow escape out of the vulval
outlet.
Delivery of head

25. 
Steps to follow:
When perineum is fully stretched
i.e.during crowning, episiotomy is
done at this stage after prior
infiltration with 10ml of 1%
lignocaine
Slow delivery of head in between
contraction is regulated.

26. 
Prevention of perineal laceration

27. 
Cont……..

28. 
Cont……

29. 
Cont………….

30. 

31. 
Delivery of shoulders

32. 
 Whole body is delivered by lateral flexion
Delivery of trunk

33.  The cord is clamped by Kocher's
forceps, the near one is placed 5cm away
from the umblicus and other one is
placed 2.5cm away from the naval.
 Then in-between the two kocker’s
forceps cut is given with cord cutting
scissor .
 Spillage of blood is prevented by
placing gauze piece near cord cutting
scissor.
Clamping and ligature
of cord

34. 
1)----------- position is to be given during 2nd stage of
labour.
Ans…Upright position
2)Show means?
Ans: mucus pug with blood.
3)Which anesthesia is used before giving episitomy?
Ans:1%lignocaine
Recaptulization

35. 
 What is a pattern of breathing during contraction?
Ans. Breathe in thro’ nose and out thro’mouth.
 What are the 3 c’s of delivery
Ans. a)Clean hands b)clean surface c)clean cutting and
ligating of cord.
Cont:

36. 