Physiology of 2nd stage labour Flashcards
What is the definition of 2nd stage labour?
traditionally defines as the time from full dilation of the cervix to the time when the baby is born
What are the signs of second stage labour?
Show (blood stained music) Position of mother Appearance of presenting part Typical variable declarations in fetal heart Dilation and gaping anus Anal cleft line/ purple line Appearance of rhomboid of Michaelis
What is the rhomboid of Michaelis?
A dome shaped curve; indicates the posterior displacement of the sacrum and coccyx as fetus moves into the maternal sacral curve
What are the factors that force the expelling of the fetus from the uterus?
Activity from the myometrium (primary power)
Muscles of the abdomen and diaphragm (secondary power)
What cab the women usually experience during labour?
Strong, regular and repetitive contractions
Involuntary pushing or bearing down
The pain in second stage of labour is often less as cervical dilation is complete, and the women is aware that progress is rapid
What happens if the position of the head is not oxiput anterior?
Then during the time between the contractions the baby will recede back and rotates
What is the passive ohase?
Full dilation of the cervix in the absence of involuntary expulsive contractions during which descent an rotation occurs
What is the active phase?
The baby is visible, and or expulsive contractions with full dilation or other signs of full dilation
What is the Ferguson reflex?
The descent of the fetus further into the vagina stimulates never receptors in the pelvic floor. Which is the is the feeling the urge to push. The urge to push may be controlled to a limited extent, but becomes increasingly compulsive and involuntary, the mother response is to employ her secondary powers (abdomen and diaphragm and muscles)
What is the early pushing urge?
Some women will experience the urge to push before the cervix is fully dilated. Change in position and asking the women to follow her instinct and encourage controlled breathing which paying close attention to maternal and fetal well being
what are the time recommendations for nulliparous in 2nd stage labour?
women birth would be expected to take place within 3 hours of the start of the active second stage in most women. Diagnose delay in the active second stage when it has lasted 2 hours and refer the women to a healthcare professional trained to undertake an operative vaginal birth if birth is not imminent.
What are some of the benefits of an upright position?
associated with a shorter stage 2
reduction in both assisted deliveries and episiotomies
less pain and easier bearing down
further well controlled studies are needed
but all women should give birth in the position they feel most comfortable in
What is the APGAR?
Appearance Pulse Grimace Activity Respiration
usually carried out twice sometimes 3 times
1 min 5 min and 10 min
