In this slide you will get to know about what is second stage of labor and what are cardinal movements in mechanism of labor and its management are discussed in this slide

1. PRESENTATION ON
SECOND STAGE OF
LABOR
Ms. Shailvi
(BSc.(H) Nursing student)

2. INTRODUCTION
During the second stage of labor
the whole tempo and nature of
activities surrounding labor tend
to change. Labor remain as a
continuum ,at this time woman
often become more vulnerable and
dependent on the influence of
those who assist them,

3. .
Discussion about alternative and
choices is not easy at this time
and this leaves the care giver
with even more than usual
responsibilities to safe guard the
interest of the mother and baby.

4. DEFINITION
The second stage of labor
begins with complete
dilatation of the cervix and
ends with the birth of the
baby . It is known as the
stage of expulsion.

5. PHYSIOLOGICAL PROCESSES
 Descend
 Uterine action
 Rupture of membranes
 Soft tissue displacement

6. DESCEND
The average maximum rate of
descend is 1.6cm/hr in
nulliparas and 5.4cm/hr in
multiparas.

7. UTERINE ACTION
Contractions during the second
stage are frequent ,strong &
slightly longer that is
approximately every 2 minutes
lasting 60-90 seconds.

8. RUPTURE OF MEMBRANES
The membranes often rupture
spontaneously at the onset of
second stage .

9. SOFT TISSUE DISPLACEMENT
As the hard fetal head
descends ,the soft tissues of
the pelvis become displaced
.
Anteriorly the bladder is
pushed upwards into the
abdomen where it is at less
risk of injury during fetal
descent .

10. PRESUMPTIVE SIGNS
OF SECOND STAGE
AND DIFFERENTIAL
DIAGNOSIS

11. MATERNAL
PHYSIOLOGICAL
CHANGES IN 2ND
STAGE

13. MECHANISM OF
NORMAL LABOR
When the fetus present in
left or right occipitoanterior
position the way the fetus is
normally situated can be
described as follows:-

18. Positional movements
ENGAGEMENT :-
Engagement takes place
when the biparietal diameter
of the fetal head has passed
through the pelvic inlet.

19. DESCEND
Descend occur throughout
the mechanism of labor and
is therefore both the
requisite to and
simultaneously with the
other mechanism.

20. FLEXION
Flexion is essential to further
descend. Pressure exerted down the
fetal axis will be transmitted to the
occiput.
The effect is to increase flexion
which result in the substitution of
smaller suboccipitobregmatic
diameter of 9.5cm for the larger
suboccipitofrontal diameter of
10cm.

21. .
.

22. INTERNAL ROTATION OF HEAD
In a well flexed vertex presentation
the occiput leads and meets the
pelvic floor first and rotates
anteriorly through 1/8th of circle.
This causes a slight twist in the
neck of the fetus as the head is no
longer in direct allignment with the
shoulders.

23. CROWNING
At this stage, the maximum
diameter of the head stretches the
vulval outfit without any recession
of the head even after the
contraction is over. This is called
crowning of head.

24. BIRTH OF THE HEAD
By further pressure from the
contracting uterus and maternal
pushing serves to further extend
the head & the head is born by
extension as the sinciput face &
chin sequentially sweep over
perineum.

25. RESTITUTION
Restitution untwist the neck so
that the head is again at right
angle with the shoulders . The
occiput moves1/8th of circle
towards the side from which it
started .

26. INTERNAL ROTATION OF SHOULDER
The anterior shoulder reaches
the pelvic floor and rotates
anteriorly1/8th of a circle .
The shoulder come to lie in the
anteriorposterior diameter of
the pelvic outlet.

27. EXTERNAL ROTATION OF THE HEAD
It occurs as the shoulders rotate 45
degree internally causing the head
to rotate another 45 degree.
External rotation occurs in the
same direction as restitution and
the occiput of the fetal head now
lies laterally.

28. BIRTH OF THE SHOULDER AND BODY
BY LATERAL FLEXION
The anterior shoulder comes into
view at the vaginal orifice where it
impinges under the symphysis
pubis while the posterior shoulder
distends the perineum.
After the shoulder are delivered the
remainder of the body is born by
lateral flexion.

30. MANAGEMENT OF SECOND
STAGE OF LABOR
PRINCIPLES
To assist in natural expulsion of
the fetus slowly and steadily.
To prevent perineal injuries.

31. GENERAL MEASURES
The patient should be in bed.
Constant supervision is
mandatory and FHR is recorded
at every 5 minutes.
To administer inhalation
analgesics if available in the
form of gas N2O and O2 to
relieve pain during
contractions.

32. . Vaginal examination is done at
the beginning of 2nd stage not
only to confirm its onset but to
detect any accidental cord
prolapse.
The position and the station of
the head are once more to be
reviewed and the progressive
descent of the head is ensured.

33. PREPARATION FOR DELIVERY
 Position.
 The accoucheur scrubs up.
 Toileting the external genitalia and inner
side of thighs with betadine.
 Essential aseptic procedures are
remembered as three Cs.
 Clean hands.
 Clean surface.
 Clean cutting and ligaturing of the cord.
 To catheterize the bladder if it is full.

34. CONDUCTION OF DELIVERY
Delivery of the head.
The patient is encouraged for
the bearing down efforts during
contractions . This fascilitates
descent of the head.

35. .
When the scalp is visible for
about 5cm in diameter, flexion
of head is maintained during
contractions.
This is achieved by pushing the
occiput downward and
backward by using thumb and
index finger of left hand while
processing the perineum by the
right palm with a sterile vulval
pad.

36. .
If the patient passes stool it
should be cleaned.
When the perineum is fully
stretched and threatens to
tear especially in
primigravidae episiotomy is
done at this stage.

37. .
Slow delivery of the head in
between the contractions is to
be regulated.
The forehead , nose ,mouth and
the chin are thus born
successively over the stretched
perineum by extension.

38. CARE FOLLOWING THE DELIVERY
OF HEAD
Mucus and blood in mouth and
pharynx to be wiped.
Eyelids are wiped with sterile dry
swabs.
The neck is palpated to exclude the
presence of any loop of cord.

39. PREVENTION OF PERINEAL
LACERATION
Delivery by early extension
is to be avoided.
Spontaneous forcible
delivery of the head is to be
avoided by assuring the
patient not to bear down
during contractions.

40. .
To deliver the head in
between contractions.
To perform timely episiotomy.
To take care during delivery
of the shoulder as the wider
bisacromial diameter
emerges out of the introitus.

41. DELIVERY OF SHOULDER
The head is to be grasped both
the hands and is gently drawn
posteriorly until the anterior
shoulder is released under the
pubis.
By drawing the head in upward
direction the posterior shoulder
is delivered out of perineum.

42. .
Traction of the head should
be gentle to avoid excessive
stretching of neck causing
injury to the brachial plexus
, hematoma of the neck or
fracture of clavicle.

43. DELIVERY OF THE TRUNK
After the delivery of
shoulder the forefinger of
each hand are inserted
under the axillae & the trunk
is delivered gently by lateral
flexion.

44. IMMEDIATE CARE OF THE NEW
BORN
Soon after the delivery of the
baby it should be placed on a
tray covered with clean dry
linen.
Air passage should be cleared
by gentle suction
APGAR rating at 1 min and 5
min.

46. .
Clamping and ligature of the cord.
The cord is divided with scissors
about 1cm beyond the ligatures
taking aseptic precautions
Note presence of any abnormality
The purpose of clamping the cord
on maternal end is to prevent
soiling of the bed and to prevent
fetal blood loss.

47. .
Delay in clamping for 2-3 min or
till cessation of the cord
pulsation fascilitates transfer of
80 -100 ml of blood.
This is beneficial to mature
baby but maybe deleterious to a
preterm or low birth weight due
to hypervolemia and
hyperbilirubinemia.

48. Early clamping is done in cases of
Rh incompatibility.
Cord is usually clamped after
cleaning the airway after about 1-2
mints of birth early clamping
reduces the need of phototherapy
due to hyperbilirubinemia.
Quick check is made to detect any
gross abnormality .

49. SUMMARY

50. CONCLUSION
1)Over the course of second
stage of labor upright and lateral
positions may have more
potential benefits improving
maternal and neonatal outcomes
and dealing with certain obstetric
complications .

51. .
2) However when woman gives
birth in upright position
especially in squatting and
sitting position midwives should
pay close attention to the
perineum to prevent perineal
trauma.
3) Midwives play a roll in child
birth so she should master the
skills and techniques.

52. BIBLIOGRAPHY
Dutta DC. Textbook of obstetrics.
9th edition. New delhi:jaypee
brothers publication; 2018.page no.
128-130.
Jacob anamma. Textbook of
obstetrics and midwifery. 3rd
edition;new delhi: jaypee brothers
publication 2012. Page no. 166- 182.

53. EVALUATION

54. THANK YOU